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Published on: March 27, 2018
[Application of bilateral internal mammary artery in coronary artery bypass grafting]
Yongqiang Lai1, Fangjiong Huang, Jinfei Yang
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Insights
Bilateral internal mammary artery grafts show effective short-term results in coronary artery bypass grafting (CABG). All patients remained angina-free with unobstructed grafts during follow-up.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Coronary artery disease (CAD) necessitates surgical intervention like coronary artery bypass grafting (CABG).
- Internal mammary arteries are increasingly utilized as conduits in CABG due to their patency rates.
- The application of bilateral internal mammary artery (BIMA) grafts in CABG is explored for its efficacy.
Purpose:
- To evaluate the clinical outcomes and graft patency of bilateral internal mammary artery grafts in patients undergoing CABG.
- To assess the short-term efficacy and safety of BIMA grafting in a cohort of male patients with coronary arteriosclerotic cardiopathy.
Summary:
- A study involving 51 male patients (average age 49.9 years) undergoing CABG utilized bilateral internal mammary artery grafts.
- The study involved various anastomosis patterns, including right internal mammary artery (RIMA) to LAD and left internal mammary artery (LIMA) to OM, among others.
- Early operative mortality was 5.9%, with complications including low output syndrome, arrhythmia, and cerebral accident. Follow-up showed no angina and unobstructed grafts via ultrasonography.
Impact:
- Bilateral internal mammary artery grafts demonstrate effective short-term application in CABG.
- The findings suggest BIMA grafts are a viable option, particularly for younger patients, offering good graft patency.
- This study contributes to the understanding of BIMA graft utility in improving CABG outcomes.
Objective:
To evaluate the effects of application of bilateral internal mammary artery grafts in coronary artery by pass grafting (CABG).
Methods:
From Jan. 1998 to Mar. 2001, 51 patients with coronary arteriosclerotic cardiopathy, all males, aged 36 - 65 (average 49.9 years), underwent coronary artery bypass grafting with bilateral internal mammary artery grafts. The pathologic change involved three branches of coronary artery in 48 cases and involved the left main trunk in 3 cases. 37 patients had the history of myocardial infarction. Four cases were complicated by left ventricular aneurysm. 47 cases were operated upon on-pump and 4 off-pump. Left ventricular aneurysmectomy was done in 4 patients and coronary endarterectomy in 1 patient. The patterns of anastomosis were as follows: right internal mammary artery (RIMA) to left anterior descending artery (LAD) and left internal mammary artery (LIMA) to obtuse marginal (OM) in 39 cases, LIMA to LAD and RIMA to right coronary artery (RCA) in 9 cases, and LIMA to LAD and RIMA to OM in 3 cases. Gastroepiploic artery and left radical artery were used in other bypass grafting. The average number of grafts used for each case was 3.
Results:
There were 3 early operative deaths, with an early operative mortality rate of 5.9%. One patient died of low output syndrome due to perioperative myocardial infection, 1 patient died of refractory arrhythmia, and 1 patient died of cerebral accident 40 days after operation. Intraaortic balloon pump was used in 4 cases post-operatively. Mediastinal infection occurred in 2 patients. The patients were followed up for 2 to 39 months (average 15.5 months). During the follow-up, no angina pectoris occurred and ultrasonography showed that the bilateral internal mammary artery grafts were unobstructed in all patients.
Conclusion:
Bilateral internal mammary artery grafts can be applied effectively in CABG with a good short-term effect, especially for young patients.
