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Ann Thorac Surg 2001;71:554
© 2001 The Society of Thoracic Surgeons

Invited commentary

Verdi J. DiSesa, MDa

a Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke’s Medical Center, 1725 West Harrison St, Suite 1156, Chicago, IL 60612, USA

e-mail: verdi_disesa{at}rush.edu

This article reports a retrospective, uncontrolled review of outcomes in 634 patients undergoing coronary artery bypass grafting using bilateral "skeletonized" internal mammary arteries. The investigators analyzed results by dividing patients into five age cohorts. They achieved excellent results in all age groups including the 92 patients older than 75 years. Perioperative mortality and morbidity including stroke, myocardial infarction, and wound infection were low and no higher in older patients in whom only long-term risk of death was increased. They ascribe these satisfactory outcomes both to use of bilateral internal mammary artery grafts and to the skeletonizing technique of mobilizing them.

This report is well done and potentially important, although with the familiar limitations of retrospective, uncontrolled series. It is particularly useful in its careful description of the technique of skeletonized mammary artery takedown, as these investigators state that this procedure contributed significantly to their excellent results. They also observed higher rates of return of angina in younger patients and ascribe this to a number of potential factors including an excess of risk factors and lower levels of compliance. They have acknowledged, however, that the higher rates of late death in older patients may explain their "reduced" rates of recurrent chest pain.

In summary, this study lends further support to the aggressive surgical management of the elderly patients with coronary artery disease who represent an increasing proportion of the contemporary cardiac surgeon’s practice.


Related Article

Effect of age on outcome of bilateral skeletonized internal thoracic artery grafting
Jacob Gurevitch, Menachem Matsa, Yosef Paz, Amir Kramer, Dimitri Pevni, Itzhak Shapira, and Rephael Mohr
Ann. Thorac. Surg. 2001 71: 549-554. [Abstract] [Full Text] [PDF]




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