Off-pump total arterial bypass grafting for the elderly does not improve life expectancy.

Abstract

Objectives: To assess whether total arterial revascularization (TAR) offers survival and freedom from major adverse cardiac or cerebrovascular events (MACCE) benefit in elderly patients with multivessel coronary artery disease undergoing off-pump coronary artery bypass grafting (OPCAB), as compared to using a single internal thoracic artery (ITA) with additional saphenous vein graft (SVG).

Methods: We retrospectively analyzed 598 patients aged >70 years who underwent coronary revascularization from August 2017-July 2023. After excluding high-risk patients and those with SVG plus more than two arterial grafts, 428 patients remained (101, TAR group; 327, single ITA + SVG group). A propensity score was used to create the TAR and single ITA + SVG groups with 1:1 ratio (100 patients in each group). Moreover, matching was performed based on eight covariates with preoperative clinical characteristics.

Results: The unmatched cohort had 70 (69.3%) and 178 (54.4%) men in the TAR and ITA + SVG groups, respectively (mean age, 74.1 ± 3.5 and 75.2 ± 4.2 years, respectively). After matching, both groups had similar demographics. The survival (p = 0.410) and MACCE-free rates (p = 0.494) over 5 years were not significantly different between the two groups. Univariable analysis showed that TAR [hazard ratio (HR) = 0.74, 95% confidence interval (CI) = 0.44-1.22, p = 0.233] and complete revascularization (HR = 0.61, 95%CI = 0.34-1.09, p = 0.094) were not significant risk factors for long-term mortality.

Conclusion: Elderly patients who underwent OPCAB with total arterial grafting did not show survival or free-MACCE benefits for over 5 years.