End of the Millenium - End of the Single Thoracic Artery Graft? Two Thoracic Arteries - Standard for the Next Millenium?* - Early Clinical Results and Analysis of Risk Factors in 1,487 Patients with Bilateral Internal Thoracic Artery Grafts -

Abstract

The 30-day lethality was 1.6% in the BIMA group, 1.7% in the SIMA group in patients under 70, and 4.1% (BIMA) and 4.0% (SIMA) in patients over 70 (p = n.s.). A significantly higher blood loss was observed in the BIMA group (BIMA 979+/-708 ml, SIMA 790+/-575 ml, p<0.05). The rethoracotomy rate due to bleeding was significantly higher in patients with BIMA (4.1%) compared to those with SIMA (2.5%, p<0.05). In patients with a body mass index (BMI) of less than 27, no significant difference could be found (SIMA 2.8%, BIMA 3.4%, p = n. s.). Patients with a BMI >27 showed a significantly higher rethoracotomy rate (SIMA 2.2%, BIMA 4.9%). A higher incidence of sternal instabilities could be observed in the BIMA group (4.2%, p<0.05). Diabetes mellitus could not be identified as an independent risk factor for sternal complications (SIMA 2.9%, BIMA 5.0%, p = n. s.). COUCLUSION: CABG using both IMA's can be performed in nearly all patients as a routine method with good clinical results and low mortality. Bleeding in the BIMA group within 48 hours was increased. BMI >27 could be identified as a risk factor for sternal complications, but not diabetes mellitus or age over 70 years.

On-Pump versus Off-Pump Complete Arterial Revascularization Using Bilateral Internal Mammary Arteries and the T-Graft Technique: Clinical and Angiographic Results for 3,445 Patients in 13 Years of Follow-Up

“…In the insulin-dependent diabetic patients, the incidence of deep sternal wound infection increased from 1.5 to 3.2% in the on-pump group and from 0.4 to 2.4% in the off-pump group, in comparison to nondiabetic patients; this is in agreement with other studies [5,6,15,20]. …”

“…On the other hand, increased perioperative mortality, a higher incidence of reoperation for bleeding and other complications have been reported using bilateral IMA-grafting [5,6]. …”

Outcomes and Patency of Complex Configurations of Composite Grafts Using Bilateral Internal Thoracic Arteries

“…Although previous studies have shown no difference in long-term survival or freedom from repeat revascularization between different BITA configurations [12][13][14][15][16][17][18][19][20], and although those studies have also shown that no particular configuration is associated with relatively favorable clinical outcomes, our study revealed that certain aspects of the configuration must be considered. The selection of the ideal BITA configuration should be based on technical factors associated with the individual patient.…”

Does bilateral ITA grafting increase perioperative complications?☆Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass

“…However, one of our previous studies involving 1487 unselected patients with bilateral ITA grafting [7] did not show any higher mortality after BITA grafting. In this previous study, a higher incidence of sternal complications occurred only in patients with body mass index > 27, neither diabetes mellitus nor advanced age influenced these complications [7]. Now, four years later, with the experience of nearly 5000 bilateral ITA bypasses, the results have changed.…”

“…While bilateral internal thoracic artery (BITA) can improve long-term survival [1][2][3][4][5], some reports have shown an increased perioperative mortality, a higher incidence of complications, or reoperations for bleeding [6][7][8] as well as the absence of a significant benefit after BITA grafting.…”