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Human Internal Mammary Artery IMA Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
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Bilateral versus unilateral internal mammary revascularization in patients with diabetes

Masahiro Endo1, Yasuko Tomizawa, Hiroshi Nishida

  • 1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Endo@hij.twmu.ac.jp

Circulation
|August 27, 2003
PubMed

Insights

Bilateral internal mammary artery (BIMA) grafts improve graft patency and long-term survival in diabetic patients undergoing coronary artery bypass grafting (CABG) with preserved ejection fraction. However, reduced ejection fraction limits the survival benefit of BIMA grafts.

Area of Science:

  • Cardiovascular Surgery
  • Diabetology
  • Thoracic Surgery

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for multivessel disease.
  • The use of internal mammary artery (IMA) grafts is standard practice.
  • The benefit of bilateral IMA (BIMA) grafts in diabetic patients remains a subject of investigation.

Purpose of the Study:

  • To evaluate the efficacy of BIMA grafts compared to single IMA (SIMA) grafts in diabetic patients undergoing CABG.
  • To assess early and long-term outcomes, including graft patency and survival rates.
  • To determine if ejection fraction influences the benefit of BIMA grafts.

Main Methods:

  • Historical cohort study of 1131 patients undergoing isolated, primary, multiple CABG with skeletonized IMA grafts.
  • Comparison between diabetic patients receiving SIMA (n=277) and BIMA (n=190) grafts.
  • Median follow-up of 8.1 years, analyzing graft patency, hospital mortality, and long-term survival.

Main Results:

  • Early graft patency was significantly higher with BIMA (97.7%) versus SIMA (93.8%).
  • No significant difference in overall survival rates between SIMA and BIMA groups.
  • In patients with preserved ejection fraction, BIMA use was associated with significantly higher 10-year survival and improved freedom from adverse cardiac events.

Conclusions:

  • Skeletonized BIMA grafts offer significant benefits in coronary revascularization for diabetic patients with preserved ejection fraction.
  • The survival benefit of BIMA grafts is limited in diabetic patients with reduced ejection fraction due to higher cardiac mortality.
  • BIMA grafting should be considered in selected diabetic patients to improve long-term outcomes.
Abstract

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