Short-term results of bilateral internal mammary arterial grafting for patients aged 60–75 years – a retrospective study

Abstract

Background Bilateral internal mammary artery (BIMA) grafting has a good long-term survival rate and graft patency rate, but it is only recommended in young patients due to its high technical requirements and high incidence of sternal complications. Previous studies indicated that BIMA grafting has a significant benefit in patients aged 50–59 years, but this benefit does not extend to patients aged > 60 years. Thus, this study was designed to analyse the immediate artery graft function, short-term (3 months) results, and experience in preventing sternal complications for BIMA grafting in elderly patients (60–75 years old). Methods Clinical records and echocardiographic and coronary artery computed tomography angiography data of 155 patients who underwent BIMA grafting for coronary artery disease between 2015 and 2017 in our hospital were analysed retrospectively to summarise the operative experience and short-term (3 months) results. Patients were divided into two groups: Group A (n = 95), aged < 60 years and Group B (n = 60), aged 60–75 years. The operation time, aortic clamp time, and cardiopulmonary bypass time of these two groups were compared to analyse the operation difficulty and the flow and pulsatility index were compared to analyse the immediate artery graft function. The left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) of these two groups were compared to analyse heart function. Results There were no significant differences in the operation time, aortic clamp time, and cardiopulmonary bypass time as well as the flow and pulsatility index between these two groups (P > 0.05). There was no significant difference in the incidence of sternal wound complications, graft occlusion, and other common complications 3 months post-BIMA grafting between these two groups (P > 0.05). Furthermore, there was no significant difference in LVEDD and LVEF between the groups 3 months post-operation (P > 0.05). Conclusions BIMA grafting was safe and effective for older patients (60–75 years). Similar to younger patients (< 60 years), BIMA grafting in elderly patients (60–75 years) can also achieve a satisfactory short-term (3 months) result. Thus, advanced age (60–75 years) should not be a contraindication for BIMA grafting.

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

“…Owing to not need extra incisions and the advantages of not being spasmodic, RIMA has been the rst choice as the second arterial conduit. However, due to high technical requirements, the long operation time, and high incidence rate of sternal wound complications, the use of BIMA grafting is limited, about 5% worldwide, and it is only recommended for younger patients [6]. From 1999 to 2009, the application proportion of BIMA in the United States was stable at around 4%, with almost no signi cant change [13].…”

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

“…A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery [3][4][5]. While, owing to high technical requirements, the long operation time, and high incidence rate of sternal wound complications, the use of BIMA grafting is limited, about 5% worldwide, and it is only recommended for younger patients [6]. And there is still no consensus on how is the best con guration to use BIMA [5].…”