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[Use of both internal mammary arteries; not everything is advantageous]
Insights
Using both internal mammary arteries for aortocoronary bypass showed higher rates of sternal dehiscence and mediastinitis compared to single grafts. However, continuous povidone-iodine flushing effectively treated these complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- The internal mammary artery is the preferred graft for aortocoronary bypass due to superior long-term outcomes compared to the internal saphenous vein.
- Graft choice significantly impacts surgical success and patient recovery in coronary artery bypass grafting.
Purpose of the Study:
- To evaluate the outcomes of using bilateral internal mammary arteries in aortocoronary bypass procedures.
- To compare the incidence of sternal dehiscence and mediastinitis between bilateral internal mammary artery grafts and single grafts (internal saphenous vein and/or single internal mammary artery).
Main Methods:
- Retrospective analysis of 21 patients undergoing aortocoronary bypass with bilateral internal mammary arteries.
- Comparison of complication rates (sternal dehiscence, mediastinitis) with a control group of 182 patients receiving single grafts.
- Assessment of treatment efficacy for sternal dehiscence and mediastinitis using continuous povidone-iodine flushing.
Main Results:
- Four patients (19.04%) who received bilateral internal mammary arteries required reoperation for sternal dehiscence, with two (9.52%) developing mediastinitis.
- The control group (single grafts) experienced 8 cases of sternal dehiscence (4.39%) and 1 case of mediastinitis (0.55%).
- Continuous povidone-iodine flushing was successful in treating sternal dehiscence and mediastinitis in affected patients.
Conclusions:
- While bilateral internal mammary artery grafting may increase the risk of sternal dehiscence and mediastinitis, these complications are treatable.
- The study highlights a statistically significant difference in complication rates between bilateral and single graft strategies.
- Further research may be warranted to optimize surgical techniques and patient selection for bilateral internal mammary artery use.
Abstract:
The internal mammary artery is considered the elective graft for performing aortocoronary by-pass as its long-term results have proven better than those obtained with the internal saphenous vein. Our results in a series of 21 patients in whom both internal mammary arteries were used are reported. Four patients (19.04%) needed reoperation for sternal dehiscence and two of them had mediastinitis (9.52%). Those patients were successfully treated by continuous povidone-iodine flushing. A clear statistical difference was found between this group of patients, in whom both internal mammary arteries were used, and the rest of the patients (182 patients) in whom just the internal saphenous vein and/or only one internal mammary artery was used. The second group presented 8 cases of sternal dehiscence (4.39%) and 1 mediastinitis (0.55%).