Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly
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- Nicolini Francesco
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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- Vezzani Antonella
- Cardiac Surgery Intensive Care Unit, Parma University Hospital
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- Romano Giorgio
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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- Carino Davide
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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- Ricci Matteo
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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- Chicco Maria Vincenza Di
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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- Gherli Tiziano
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
Bibliographic Information
- Other Title
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- Where Do We Stand?
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Description
<p>Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.</p><p>The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.</p><p>There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.</p>
Journal
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- International Heart Journal
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International Heart Journal 58 (5), 647-653, 2017
International Heart Journal Association
