Original Articles
Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits

https://doi.org/10.1016/S0003-4975(99)00282-9Get rights and content

Abstract

Background. To increase the number of anastomoses per patient, bilateral internal mammary arteries (BIMAs) were harvested with a skeletonized approach instead of a pedicled one.

Methods. One thousand one hundred forty-six patients underwent isolated myocardial revascularization using BIMAs, 304 receiving pedicled grafts (group A, October 1991 through May 1994) and 842 receiving skeletonized conduits (group B, June 1994 through June 1998). Group B had a higher incidence of patients with diabetes (223 versus 40, p < 0.001).

Results. The number of BIMA anastomoses per patient was significantly higher in group B (2.4 ± 0.3 versus 2.1 ± 0.4, p < 0.001), as well as the number of sequential grafts (288 versus 42, p < 0.001). Twenty-three patients (2.0%) died in the first 30 days after surgery, 5 in group A (1.6%) and 18 in group B (2.1%) (not significant). Postoperative complications were similar in both groups; the incidence of sternal wound healing problems was higher as a whole and with regard to diabetic patients (4 of 40 [10%] versus 5 of 223 [2.2%], p < 0.05) in group A. Seventy-one patients in group A and 133 (15.8%) in group B underwent a postoperative angiography. Patency rate was similar, both early (100% in group A versus 98.6% in group B, not significant) and late (98.6% in group A versus 98.4% in group B, not significant).

Conclusions. The use of skeletonized BIMA conduits allowed us to increase the number of BIMA anastomoses per patient with a lower rate of sternal wound complications and angiographic results similar to those obtained with pedicled BIMA conduits.

Section snippets

Material and methods

From October 1991 to May 1994, 304 patients underwent isolated myocardial revascularization using pedicled BIMA conduits (group A); from June 1994 to June 1998, 842 patients underwent the same operation using skeletonized BIMA conduits (group B). Table 1shows the preoperative data.

Results

Preoperative data in both groups were not similar, because the population was older, with lower ejection fraction and with more redo patients in group B (Table 1), owing to the modification with time of the coronary population.

The CPB time was longer in group A (69.0 ± 19.9 versus 59.8 ± 19.2 minutes, p < 0.001), but the cross-clamping time was similar (50.5 ± 14.2 versus 51.5 ± 16.8 minutes, not significant, in groups A and B, respectively). However, in 157 patients in group B, CPB was not

Comment

The use of BIMA conduits in coronary artery operations is essentially a technical problem. Even if there is not clear demonstration that in the long term the use of BIMA conduits is superior to the use of a single LIMA on the LAD, plus one or more saphenous vein grafts, there is no clear demonstration of the contrary. This means that, if the use of the second IMA does not give technical problems, there is no reason not to use it.

One of the major concerns is the increase of postoperative

Cited by (161)

  • Bilateral internal thoracic artery grafting strategies

    2020, Technical Aspects of Modern Coronary Artery Bypass Surgery
  • Harvesting the skeletonized internal thoracic artery using the harmonic scalpel

    2020, Technical Aspects of Modern Coronary Artery Bypass Surgery
View all citing articles on Scopus
View full text