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Published on: March 27, 2018
[Coronary artery bypass graft surgery with bilateral internal mammary artery. Short-term results]
Josías Caleb Ríos Ortega1, Paul Castañeda Castillo2, Luisa Talledo Paredes3
1Servicio de Cirugía Cardíaca, Instituto Nacional Cardiovascular, INCOR, EsSalud, Lima, Perú.
Insights
Coronary artery bypass graft (CABG) surgery using bilateral internal mammary arteries (BIMA) demonstrated 0% mortality and low cardiovascular events in a 30-day follow-up. This safe surgical approach is effective for multivessel coronary disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass graft (CABG) surgery is the standard treatment for multivessel coronary disease.
- Bilateral internal mammary artery (BIMA) grafting shows improved long-term survival rates compared to single grafts.
Purpose of the Study:
- To evaluate the safety and efficacy of CABG using BIMA.
- To determine 30-day mortality and major cardiovascular events following BIMA CABG.
Main Methods:
- Retrospective study of 36 patients undergoing CABG with BIMA.
- Data collected from January 2012 to December 2015 at the National Cardiovascular Institute, Peru.
- Assessment of 30-day mortality, major adverse cardiovascular events, and surgical site infections.
Main Results:
- Zero percent 30-day mortality.
- 5.56% incidence of major cardiovascular events, including postoperative myocardial infarction.
- 0% incidence of mediastinitis or sternal reconstruction; superficial wound infection in 7 patients without significant difference between diabetic/non-diabetic or overweight/non-overweight groups.
Conclusions:
- CABG with BIMA is a safe procedure with low short-term mortality.
- The technique is associated with minimal major cardiovascular events in the early postoperative period.
Introduction:
Coronary artery bypass graft (CABG) surgery remains the reference standard in the treatment of multivessel coronary disease. Several studies have shown that CABG with bilateral internal mammary arteries (BIMA) has better results in long-term survival.
Methodology:
A retrospective study was conducted on CABG surgeries with BIMA from January 2012 to December 2015 in the National Cardiovascular Institute, INCOR, EsSalud, Peru. The objectives were to determine the mortality and major cardiovascular events at 30 days follow-up.
Results:
Of the 36 patients subjected to CABG surgery with BIMA, the 30-day mortality was 0%, with major cardiovascular events occurring in 5.56% of patients (Stroke 0%, postoperative myocardial infarction 5.56%, need of new coronary intervention 0%). The incidence of mediastinitis and/or sternal reconstruction was 0%. Superficial wound infection was observed in 7 patients, with there being no significant difference between diabetics and non-diabetics (25% vs. 16.66%, OR=3.3, P=.88), or between patients with or without overweight (19.23% vs. 20%, respectively, OR=.95; 95% CI, P=.68).
Conclusions:
CABG surgery with BIMA is a safe procedure, with low rates of mortality and major cardiovascular events in the short-term.
