Off-pump total arterial bypass grafting for the elderly does not improve life expectancy
ObjectivesTo 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...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1598770/full |
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| author | Nuttapon Arayawudhikul Ryohei Ushioda Ryohei Ushioda Hideki Isa Hideki Isa Dit Yoongtong Boonsap Sakboon Jaroen Cheewinmethasiri Thanin Lokeskrawee Jayanton Patumanond Suppachai Lawanaskol Hiroyuki Kamiya |
| author_facet | Nuttapon Arayawudhikul Ryohei Ushioda Ryohei Ushioda Hideki Isa Hideki Isa Dit Yoongtong Boonsap Sakboon Jaroen Cheewinmethasiri Thanin Lokeskrawee Jayanton Patumanond Suppachai Lawanaskol Hiroyuki Kamiya |
| author_sort | Nuttapon Arayawudhikul |
| collection | DOAJ |
| description | ObjectivesTo 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).MethodsWe 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.ResultsThe 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.ConclusionElderly patients who underwent OPCAB with total arterial grafting did not show survival or free-MACCE benefits for over 5 years. |
| format | Article |
| id | doaj-art-8e7d9a18eca34635a4bdd0d403a4ea25 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-8e7d9a18eca34635a4bdd0d403a4ea252025-08-20T02:19:54ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-05-011210.3389/fcvm.2025.15987701598770Off-pump total arterial bypass grafting for the elderly does not improve life expectancyNuttapon Arayawudhikul0Ryohei Ushioda1Ryohei Ushioda2Hideki Isa3Hideki Isa4Dit Yoongtong5Boonsap Sakboon6Jaroen Cheewinmethasiri7Thanin Lokeskrawee8Jayanton Patumanond9Suppachai Lawanaskol10Hiroyuki Kamiya11Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, ThailandCardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, ThailandDepartment of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JapanCardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, ThailandDepartment of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JapanCardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, ThailandCardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, ThailandCardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, ThailandDepartment of Emergency Medicine, Lampang Hospital, Lampang, ThailandCenter for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandCenter for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandDepartment of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JapanObjectivesTo 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).MethodsWe 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.ResultsThe 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.ConclusionElderly patients who underwent OPCAB with total arterial grafting did not show survival or free-MACCE benefits for over 5 years.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1598770/fulloff-pump coronary artery bypass graftingtotal arterial bypass graftingmultivessel coronary artery revascularizationelderlycoronary artery disease |
| spellingShingle | Nuttapon Arayawudhikul Ryohei Ushioda Ryohei Ushioda Hideki Isa Hideki Isa Dit Yoongtong Boonsap Sakboon Jaroen Cheewinmethasiri Thanin Lokeskrawee Jayanton Patumanond Suppachai Lawanaskol Hiroyuki Kamiya Off-pump total arterial bypass grafting for the elderly does not improve life expectancy Frontiers in Cardiovascular Medicine off-pump coronary artery bypass grafting total arterial bypass grafting multivessel coronary artery revascularization elderly coronary artery disease |
| title | Off-pump total arterial bypass grafting for the elderly does not improve life expectancy |
| title_full | Off-pump total arterial bypass grafting for the elderly does not improve life expectancy |
| title_fullStr | Off-pump total arterial bypass grafting for the elderly does not improve life expectancy |
| title_full_unstemmed | Off-pump total arterial bypass grafting for the elderly does not improve life expectancy |
| title_short | Off-pump total arterial bypass grafting for the elderly does not improve life expectancy |
| title_sort | off pump total arterial bypass grafting for the elderly does not improve life expectancy |
| topic | off-pump coronary artery bypass grafting total arterial bypass grafting multivessel coronary artery revascularization elderly coronary artery disease |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1598770/full |
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