[Advantage of internal thoracic artery for coronary arterial bypass surgery in patients over 70 years of age].

Between April 1988 and September 1991, 16 among 23 patients over 70 years of age underwent coronary bypass grafting (CABG) with at least one arterial graft. The age ranged from 70 to 77 years (mean, 72.1 years) and involved coronary lesions were two vessels in two patients and three vessels in 14 patients. Seven patients with unstable angina received emergency CABG. The number of distal anastomosis with arterial graft was mean of 1.3 per patient and left internal thoracic artery (ITA) was used as a pedicled graft in all patients. Sequential grafting with left ITA arterial graft was performed in two and right gastroepiploic artery was concomitantly used in three patients. No atherosclerosis was seen in left ITA, however, poor quality saphenous vein graft (SVG) was in five and atherosclerosis of ascending aorta was in five patients. After operation deep vein thrombosis of leg after harvesting SVG occurred in one patient. The angiogram performed within one month of operation in nine patients showed that the patency rate of arterial graft was 100% and that of SVG was 94.4%. The longest follow-up period was 42 months and New York Heart Association Functional Class improved to Class I or II in all patients. The use of pedicled ITA in elderly patient showed advantage for diseased ascending aorta and it seemed to prevent the postoperative complication due to the use of SVG.