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

## TL;DR

This study found that using total arterial grafts in elderly patients during heart surgery does not improve survival or reduce major cardiac events compared to using a single artery and vein graft.

## Contribution

The study provides new evidence that total arterial bypass grafting in elderly patients does not offer survival or event-free benefits.

## Key findings

- Survival rates were not significantly different between the TAR and ITA + SVG groups over 5 years.
- MACCE-free rates were also not significantly different between the two groups.
- TAR and complete revascularization were not significant risk factors for long-term mortality.

## Abstract

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).

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.

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.

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