Related Experiment Video
Updated: Oct 5, 2026
Human Internal Mammary Artery (IMA) Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
Published on: May 9, 2012
Efficacy of single versus bilateral internal mammary artery grafting in women: a long-term study
P A Kurlansky1, E A Traad, D L Galbut
1Miami Heart Research Institute, Miami Beach, Florida 33140, USA.
Insights
Bilateral internal mammary artery (BIMA) grafting in women shows excellent results, comparable to single internal mammary artery (SIMA) grafting. The addition of a second internal mammary artery graft does not provide additional clinical benefits for women undergoing coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) in women historically has higher mortality and less favorable long-term outcomes compared to men.
- Bilateral internal mammary artery (BIMA) grafting has demonstrated excellent results in both genders.
- The benefit of BIMA over single internal mammary artery (SIMA) grafting in women remains a subject of debate.
Purpose of the Study:
- To compare the clinical outcomes of BIMA versus SIMA grafting in a cohort of women undergoing CABG.
- To evaluate the perioperative and long-term benefits of using two internal mammary arteries compared to one in female patients.
Main Methods:
- A retrospective analysis compared 261 women who received BIMA and vein grafts with 261 computer-matched women who received SIMA and vein grafts.
- The study period was from January 1972 to October 1994.
- Univariate analysis confirmed group homogeneity based on nine preoperative variables.
Main Results:
- Operative mortality was similar between BIMA (3.4%) and SIMA (3.8%) groups, with significant reductions observed post-1990 in both.
- Mean graft numbers, perfusion, and cross-clamp times were comparable.
- No significant differences were found in postoperative complications, including sternal wound infection, late myocardial infarction, reoperation rates, or quality of life (SF-36).
- Excellent clinical outcomes (Canadian Cardiovascular Society class I or II) were achieved in 100% of patients in both groups at long-term follow-up (mean 9-10 years).
Conclusions:
- Internal mammary artery grafting in women yields excellent short- and long-term results.
- The addition of a second internal mammary artery graft (BIMA) does not confer additional clinical benefits compared to SIMA in a matched cohort of women.
- Both BIMA and SIMA strategies are effective for women undergoing CABG.
Background:
Coronary artery bypass grafting carries a higher operative mortality and less favorable long-term benefit in women than in men. Bilateral internal mammary artery grafting (BIMA) has been shown to yield excellent perioperative and long-term results in both women and men. However, controversy continues to exist as to the benefits of a second internal mammary artery graft in women.
Methods:
A retrospective analysis was performed comparing 261 consecutive women from a single surgical practice receiving BIMA and supplemental vein grafts between January 1972 and October 1994 with a computer-matched cohort of 261 women receiving single internal mammary artery (SIMA) and vein grafts during the same period. Univariate analysis confirmed the homogeneity of the two groups based on nine preoperative variables.
Results:
Operative mortality was comparable in the two groups, 3.8% (10 of 261 patients) in the SIMA and 3.4% (9 of 261 patients) in the BIMA group, with a markedly reduced mortality in both groups since 1990, 2.3% (2 of 86 patients) in the SIMA and 1.3% (1 of 78 patients) in the BIMA group. The mean number of distal grafts (2.78, SIMA; 3.14, BIMA), perfusion time (104 minutes, SIMA; 108 minutes, BIMA), and cross-clamp time (58 minutes, SIMA; 66 minutes, BIMA) were all comparable. There was no significant difference in the incidence of postoperative complications, including sternal wound infection. Patient follow-up ranged from 1 month to 27 years, with a mean of 10.0 years in the SIMA group and 9.1 years in the BIMA group. Clinical results were excellent, with 100% (136 of 136 patients) of the SIMA and 100% (167 of 167 patients) of the BIMA patients in Canadian Cardiovascular Society class I or II at follow-up. Rates of late myocardial infarction, percutaneous transluminal coronary angioplasty, and reoperation were similarly low in both groups: 3.7% (5 of 136 patients) versus 1.8% (3 of 166 patients), 5.4% (7 of 136 patients) versus 4.8% (8 of 166 patients), and 3.7% (5 of 136 patients) versus 1.8% (3 of 166 patients), for SIMA versus BIMA survivors, respectively. No significant difference was found in the long-term and event-free survival or in any of the eight subscales of the SF-36 quality of life survey for the two groups.
Conclusions:
Excellent short- and long-term results have been demonstrated with internal mammary artery grafting in women. However, the addition of a second internal mammary artery graft does not appear to confer any additional clinical benefits in a comparably matched cohort of patients.
