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The Annals of Thoracic Surgery, Vol 49, 188-193, Copyright © 1990 by The Society of Thoracic Surgeons
TJ Gardner, PS Greene, MF Rykiel, WA Baumgartner, DE Cameron, AS Casale, VL Gott, L Watkins Jr and BA Reitz
Left internal mammary artery (LIMA) grafts have better long-term patency
rates than do saphenous vein grafts and result in improved late survival.
The present study was undertaken to assess the results of LIMA grafting in
the elderly. From 1980 through 1988, 723 patients 70 years of age or older
had isolated coronary artery bypass grafting performed. During the first 5
years, only 11% of the elderly patients received LIMA grafts, whereas 86%
having coronary artery bypass grafting since 1985 had LIMA grafts. Since
1986, LIMA use in the elderly has become routine, with 92% of patients
receiving internal mammary artery grafts. During the first 5 years, elderly
patients had a hospital mortality rate of 9.3%. Since 1985, the hospital
mortality rate fell to 5.5%. In addition, the occurrence of major surgical
complications was either unchanged or reduced in patients receiving LIMA
grafts. Furthermore, late follow-up indicates a significantly improved
4-year survival rate in patients with internal mammary artery grafts
compared with those without: 86 +/- 0.02% versus 77 +/- 0.03% (p less than
0.01). Analysis of multiple potential risk factors for early mortality was
performed using multiple logistic regression and late survival using the
Cox proportional hazards model. Although unmeasured predictor variables may
confound retrospective analyses, LIMA grafting appears to be an independent
predictor both of improved early and late survival.
ARTICLES
Routine use of the left internal mammary artery graft in the elderly
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21205.
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