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Eur J Cardiothorac Surg 2001;20:120-126
© 2001 Elsevier Science NL
a Department of Cardiac Surgery, University of Heidelberg, Neuenheimer Feld 110D-69120, Heidelberg, Germany
b The Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery, Department of Biostatistics and Epidemiology, Cleveland, OH, USA
Received 11 November 2000; received in revised form 13 March 2001; accepted 4 April 2001.
Corresponding author. Tel.: +49-6221-566111; fax: +49-6221-56 5585
e-mail: brigitte_osswald{at}med.uni-heidelberg.de
Objective: Usefulness and risks of incomplete versus complete revascularization are still matters of ongoing discussions. Because an increasing number of elderly patients are undergoing coronary artery bypass grafting (CABG), the question arises whether a less extensive surgical approach is more prudent than complete revascularization. Methods: Of 6531 patients undergoing isolated CABG, 859 were 75 and older at the time of operation. Mean age of the 859 patients was 77±2.7 years (median: 76 years); 65% were men. Follow-up enquiry by questionnaire was performed at the 180th postoperative day with a completeness of 95.6%. Assessment of the impact of incomplete revascularization utilized both multivariable analysis and propensity score matching to account for selection factors. Results: Incomplete revascularization was performed in 133 patients (16%). The most common reasons for incomplete revascularization were small vessels (55%) and massive calcification (32%). Mortality until 180 days after CABG was higher (n=32; 24%) after incomplete than after complete revascularization (n=105; 15%; P=0.005). By logistic multivariable regression, incomplete revascularization was identified as an independent risk factor for death (Odds ratio, 1.8; P=0.015). By time-related analysis, incomplete revascularization predominantly affected the early period after CABG (P=0.001). Aortic cross clamping time was only slightly shorter for the group with incomplete (59±27 min (median: 55 min) vs. 63±26 min (median: 58 min); P=0.1). Conclusions: Incomplete revascularization increases the early risk of death after CABG in patients aged 75 years and older. The potential compensating benefit of the shorter aortic cross clamping time does not overweigh the advantages of complete revascularization. Thus, in the era of high-volume interventional approaches and minimally invasive techniques, the advantages of complete revascularization need to be considered.
Key Words: Coronary artery bypass grafting • Incomplete revascularization: Elderly patients
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