European Journal of Cardio-Thoracic Surgery, Vol 10, 971-975, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Bilateral skeletonized mammary artery grafting: experience with 560 consecutive patients
O Bical, E Braunberger, M Fischer, J Robinault, JC Foiret, Y Fromes, D Gaillard, P Maribas, T Bouharaoua, G Souffrant and A Vanetti
Department of Cardiac Surgery, Hopital Saint Joseph, Paris, France.
OBJECTIVE: To test the hypothesis that the skeletonized technique of
harvesting the internal thoracic artery improves the surgical results of
bilateral internal thoracic artery grafting, we reviewed our 7-year
experience with this technique. METHODS: Between July 1987 and December
1994, 560 patients received bilateral internal thoracic artery grafts and
236 additional grafts (average 2.6 +/- 0.6 anastomoses per patient). There
were 515 men (92%) and the average age was 56.9 +/- 8.8 years. There were
63 diabetic patients (11.3%). During harvesting, the internal thoracic
arteries were always totally skeletonized from the surrounding tissues
without the use of electrocautery. RESULTS: Postoperative complications
included reoperation for bleeding, 17 patients (3%), phrenic nerve paresis,
17 patients (3%), acute respiratory distress syndrome, 9 patients (1.6%),
digestive complications, 8 patients (1.4%), neurologic complications, 6
patients (1.1%), and sternal complications, 6 patients (1.1%). No wound
complications were observed in diabetic patients. The hospital mortality
rate was 1.6% (9 patients, 2 cardiac causes). The early patency of internal
thoracic artery grafts was 97.9%. Follow-up averages 29 +/- 20 months.
There were 14 late deaths (4 cardiac causes). Angina recurred in 51
patients and the maximal stress test was abnormal in 47 patients.
CONCLUSION: Bilateral internal thoracic artery grafting with skeletonized
harvesting carried low post-operative mortality and morbidity and therefore
it could be applied routinely without the fear of increased complication
rate.
