Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting

Abstract

Background-The aim of this study was to evaluate the performance of bilateral internal mammary artery (BIMA) grafts in isolated CABG. Methods and Results-Beginning in April 1985, elective primary multiple CABG for multivessel disease was performed in 1131 patients. The early and late results of 688 patients who received single internal mammary artery (SIMA) grafts and 443 patients who received BIMA grafts were compared (median follow-up, 6.15 years). Hospital mortality was not significantly different in the SIMA (0.9%) and BIMA (0.9%) groups. Graft patency was 97.3% in the BIMA group and 94.3% in the SIMA group (PϽ0.0001). The 7-year repeated CABG-free rate was significantly higher in the BIMA group (Pϭ0.026). The 7-year new myocardial infarction-free rate in all patients tended to be higher in the BIMA group (Pϭ0.06). The hazard ratio for all death or repeated CABG in patients with ejection fractions Ͼ0.4 and age Ͻ71 years was lower in the BIMA group (Pϭ0.0499). Conclusions-Our data suggest that the use of BIMA grafts in patients with in situ coronary artery anastomoses achieves a significantly higher repeated CABG-free rate in all patients compared with the use of SIMA. (Circulation. 2001;104: 2164-2170.)

Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

“…5 After surgery, blood glucose level was controlled rigorously during the intensive care unit stay. 5 The mean number of patent distal anastomoses per patient and the proportions of IMA grafts were similar in the diabetic and nondiabetic groups (Table 2). However, the mean numbers of distal anastomoses were higher using BIMA than using SIMA in both diabetic (Pϭ0.012) and nondiabetic (Pϭ0.0002) patients.…”

“…Postoperative graft angiogram was performed routinely approximately 2 weeks after surgery, 5 and 1083 patients (95.8% of all patients) underwent coronary angiography. Early graft patency was assessed on the angiograms.…”

“…All the anastomoses on cine films were reviewed for coronary stenosis by cardiologists in our institute as previously described. 5 The mean number of distal anastomoses per patient times the patency rate was calculated.…”

“…5 The use of small grafts was avoided. Diabetes mellitus (insulin-treated or nontreated) did not constitute hesitation for using BIMA grafts in elective CABG.…”

“…iabetes, [1][2][3][4] older age, 2,3,5 reduced ejection fraction (EF), 2,3,5 and chronic hemodialysis 6 are significant independent predictors of poor outcome in long-term survival after elective coronary artery bypass grafting (CABG). Diabetes mellitus is an established risk factor for mortality, whereas low EF and chronic dialysis are the worst predictors.…”