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Current Readings: Single vs Bilateral Internal Mammary Artery in Coronary Artery Bypass Grafting

Julius I Ejiofor1, Tsuyoshi Kaneko1, Sary F Aranki1

  • 1Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Seminars in Thoracic and Cardiovascular Surgery
|June 28, 2018
PubMed

Insights

Bilateral internal mammary artery (BIMA) grafting shows potential for better long-term survival, but risks like sternal infection and longer surgery times need consideration. Further data is needed to confirm its effectiveness.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Surgical Outcomes

Background:

  • Retrospective studies suggest bilateral internal mammary artery (BIMA) grafting improves long-term survival compared to single left internal mammary artery (LIMA) grafting.
  • The Arterial Revascularization Trial's interim results have not yet confirmed this survival advantage.
  • Widespread adoption of BIMA grafting faces challenges, including a higher risk of deep sternal wound infection.

Purpose of the Study:

  • To evaluate the effectiveness and risks associated with bilateral internal mammary artery (BIMA) grafting in coronary artery bypass surgery.
  • To compare long-term survival outcomes between BIMA and LIMA grafting.
  • To identify strategies for mitigating complications associated with BIMA grafting.

Main Methods:

  • Review of retrospective data and interim results from the Arterial Revascularization Trial.
  • Analysis of surgical techniques, including skeletonized harvesting and Y-graft configuration for BIMA.
  • Assessment of operative time, in-hospital costs, and sternal wound infection rates.

Main Results:

  • Retrospective data indicates superior long-term survival with BIMA grafting.
  • Interim results from the Arterial Revascularization Trial have not corroborated the survival benefit.
  • Skeletonized harvesting and Y-graft utilization may reduce infection risk and improve revascularization, respectively.
  • BIMA grafting is associated with increased operative time (approx. 25 minutes) and higher costs.

Conclusions:

  • The definitive long-term effectiveness of BIMA grafting remains uncertain pending final results of the Arterial Revascularization Trial.
  • Strategies to minimize sternal wound infection, such as skeletonized harvesting, are crucial for BIMA adoption.
  • Balancing the potential survival benefits against increased operative time, costs, and infection risks is essential.

Keywords:
BIMACABGLIMA

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