Related Experiment Videos
[Decrease of postoperative morbidity in coronary surgery using the two internal mammary arteries]
O Bical1, D Gaillard, M Fischer
1Service de Chirurgie Cardiaque, Hôpital St-Joseph, Paris.
Insights
Bilateral internal mammary artery grafting showed reduced surgical risks with increased surgeon experience. This technique became as safe as conventional coronary artery bypass grafting using saphenous veins or a single mammary artery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Context:
- Bilateral internal mammary artery grafting is a complex procedure.
- Surgical learning curves can impact patient outcomes.
Purpose:
- To analyze the surgical risk associated with bilateral internal mammary artery grafting.
- To evaluate the impact of surgical experience on outcomes.
Summary:
- A study of 100 patients undergoing bilateral internal mammary artery grafting revealed a 1% postoperative mortality.
- Outcomes improved with experience, showing decreased postoperative hemorrhage and phrenic palsy.
- No significant differences were observed in perioperative myocardial infarction or mediastinal suppuration.
Impact:
- Surgical experience significantly lowers the risks of bilateral internal mammary artery grafting.
- This technique's risk profile becomes comparable to conventional coronary artery bypass grafting.
- Enhanced safety profile supports the broader adoption of bilateral internal mammary artery grafting.
Abstract:
The surgical risk of bilateral internal mammary artery grafting was analyzed in 100 successive patients separated chronologically into two groups. These groups were not statistically different in terms of age, severity of angina, and extent of coronary artery disease. The number of grafts per patient and the time of aortic cross clamping were not statistically different in the two groups. The postoperative mortality was 1% in the 100 patients. The incidence of perioperative myocardial infarction was not statistically different in the two groups. No mediastinal suppuration was observed. The mean postoperative hemorrhage was 633 +/- 558 ml in the first 50 patients and 560 +/- 410 ml for the last 50 patients (p < 0.05). The percentage of patients receiving no homologous blood transfusion was 64% in the first 50 patients and 94% in the last 50 patients. The percentage of phrenic palsy was 36% in the first 50 patients and 6% in the last 50 patients (p < 0.05). With surgical experience, the risk of coronary bypass with bilateral internal mammary artery was lowered and very similar to the surgical risk of conventional aorto-coronary bypass with saphenous veins or one mammary artery.