The Use of the Internal Mammary Artery for Myocardial Revascularisation in Patients 70 Years of Age and Older. Does it Complicate the Early Post-Operative Period?

In the last years common agreement has been reached that the internal mammary artery (IMA) is the conduit of choice for elective myocardial revasculariation. This trend has been stimulated by the long-term patency of the IMA grafts and the better long-term survival. However, with the increase in life-expectancy, an increasing number of elderly patients is referred for coronary artery bypass grafting. In this patient population the long-term survival is generally limited, and therefore many surgeons do not use the IMA as graft. However, there is not only the better long-term survival but also a reduction in recurrence of angina, cardiac events, and need for reoperations associated with the IMA use. In this study the perioperative (peroperative and early postoperative) mortality and morbidity of coronary artery surgery with IMA use and without IMA use in patients aged 70 years and older is compared. Based on the early clinical results it is suggested that the use of an IMA graft does not influence the perioperative morbidity and mortality of coronary artery surgery in the patient over 70, who thus should not be denied the conduit of choice on such grounds.