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Bilateral mammary artery bypass and sternal dehiscence. A favorable outcome
S L Kalush1, R B Cherukuri, D Teller
1Department of Surgery, St. Mary's Hospital, Saginaw, Michigan.
Insights
Bilateral internal mammary artery bypass for coronary artery disease shows a low sternal dehiscence rate. However, female sex and diabetes increase risk, warranting caution in these patient groups.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Internal mammary artery (IMA) bypass is effective for coronary artery disease.
- Assessing sternal complications after myocardial revascularization is crucial.
- Comparing bilateral vs. unilateral IMA use provides insights into surgical risks.
Purpose of the Study:
- To evaluate the incidence of sternal dehiscence after myocardial revascularization using bilateral internal mammary arteries.
- To compare sternal complications between bilateral and unilateral internal mammary artery bypass procedures.
- To identify patient factors predisposing to sternal dehiscence.
Main Methods:
- Retrospective analysis of consecutive patients undergoing myocardial revascularization.
- Comparison of sternal dehiscence rates in patients receiving bilateral IMA grafts versus unilateral IMA grafts.
- Statistical analysis to identify risk factors for sternal dehiscence.
Main Results:
- Bilateral IMA bypass (277 patients) had a 2.52% sternal dehiscence rate (7 cases) and 0.722% operative mortality.
- Unilateral IMA bypass (413 patients) had a 0.484% sternal dehiscence rate (2 cases) and 1.21% operative mortality.
- Female sex and diabetes mellitus were identified as significant risk factors for sternal dehiscence in the bilateral IMA group.
Conclusions:
- Bilateral internal mammary artery grafting has a low incidence of sternal dehiscence, supporting its continued use.
- Caution is advised when using bilateral IMA grafts in diabetic patients, women, and elderly patients (>70 years).
- Diabetes mellitus is a key risk factor for sternal dehiscence following bilateral internal mammary artery bypass.
Abstract:
The efficacy of mammary artery bypass for coronary artery disease has been well established. The present retrospective series of consecutive patients was scrutinized to assess the incidence of sternal dehiscence following myocardial revascularization using the right and left internal mammary arteries. For comparison, the consecutive group of patients undergoing myocardial revascularization with unilateral internal mammary artery bypass was analyzed for similar sternal complications. In a consecutive series of patients, 277 patients underwent myocardial revascularization using the right and left internal mammary arteries for bypass. The overall operative mortality in this group of patients was 0.722 per cent. In this group there was an overall incidence of seven sternal dehiscences, both partial and complete for an incidence of 2.52 per cent. Upon analysis, it was shown that the female sex and diabetes were the conditions that most likely predisposed to the occurrence of sternal dehiscence whether partial or complete. For comparison, a consecutive group of 413 patients were analyzed for similar demographic data and results. The overall operative mortality in this group was 1.21 per cent. The overall incidence of sternal dehiscence both partial and complete, was 0.484 per cent. Both instances of sternal dehiscence occurred in diabetic patients and the data indicates, as in the bilateral internal mammary artery group, the presence of diabetes predisposed to the occurrence of this complication. The low overall incidence of sternal dehiscence in the expanded use of the mammary arteries should not deter the surgeon from aggressive use of the mammary arteries. One should use caution, however, in using bilateral mammary artery grafts in diabetics, women, and to a lesser extent, patients more than 70 years of age.