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[Coronary artery bypass surgery with bilateral internal mammary artery]
Insights
Bilateral internal mammary artery grafting shows no increased surgical mortality compared to single grafting. However, it may lead to a slight rise in catecholamine use, with further research needed for definitive conclusions.
Area of Science:
- Cardiovascular Surgery
- Grafting Techniques
- Surgical Outcomes
Context:
- Coronary artery bypass grafting (CABG) increasingly uses arterial grafts due to saphenous vein graft failure.
- Assessing the safety of bilateral internal mammary artery (BIMA) grafting is crucial.
Purpose:
- To evaluate the risks associated with bilateral internal mammary artery grafting versus single internal mammary artery grafting in CABG patients.
- To compare operative mortality and postoperative morbidity between the two grafting strategies.
Summary:
- A study matched patients undergoing CABG based on risk factors, comparing those receiving one internal mammary artery graft to those receiving two.
- Operative mortality was zero in both groups. Morbidity showed no significant differences, except for a slight increase in transfusion, wound infection, and catecholamine use in the BIMA group.
- Bilateral internal mammary artery grafting does not appear to increase surgical mortality but may increase catecholamine requirements.
Impact:
- Findings suggest BIMA grafting is a safe alternative regarding mortality, but potential increases in specific morbidities warrant consideration.
- This research informs surgical decisions in CABG, balancing graft longevity with perioperative risks.
- Further studies with larger cohorts are recommended to solidify conclusions on BIMA grafting safety and outcomes.
Abstract:
Increasing number of coronary artery bypass surgery has been performed utilizing more arterial grafts because of poor long term patency rate of saphenous vein grafts. The risk of bilateral internal mammary artery grafting was studied in two groups of patients who were matched for recognized risk factors such as year of operation, age, gender, extent of coronary artery disease, left ventricular function, completeness of myocardial revascularization, and history of congestive heart failure. The patient groups differed in the fact that they received on internal mammary artery graft or two internal mammary artery grafts. The operative mortality rate was zero in either group. Analysis of operative and postoperative morbidity demonstrated no significant differences except for a slight increase in transfusion requirement, rate of wound infection and use of catecholamine in the group receiving two internal mammary artery grafts (p = 0.1, 0.1 and 0.05, respectively). We conclude at this moment that bilateral internal mammary artery grafting does not increase surgical mortality but increases the use of catecholamine comparing with the ipsilateral internal mammary artery grafting. Since the cases analysed in this study are limited, definitive conclusion should be deferred.