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Eur J Cardiothorac Surg 2005;28:120-126
© 2005 Elsevier Science NL

Skeletonized bilateral internal mammary arteries for non-elective surgical revascularization in unstable angina

^a Department of Cardiac Surgery, Cattedra e Scuola di Specializzazione in Cardiochirurgia, University of Florence, Viale Morgagni, 85, Careggi, 50134 Firenze, Italy
^b Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Canada
^c Division of Cardiac Surgery, Azienda Universitario-Ospedaliera ‘Careggi’, Firenze, Italy
^d Brigham and Women's Hospital, Harvard University, Boston, USA

Received 5 October 2004; received in revised form 7 March 2005; accepted 30 March 2005.

^* Corresponding author. Tel.: +39 338 9855782; fax: +39 055 4277458. (Email: mbonacchi{at}unifi.it).

Objective: The aim of this study was to evaluate the feasibility, safety and outcome of skeletonized bilateral internal mammary arteries (BIMA) in patients with unstable angina (UA) undergoing non-elective myocardial revascularization. Methods: Between January 1997 and December 2003, 758 patients, mean age 62±12 years, underwent non-elective coronary artery bypass grafting (CABG) for unstable angina. Two hundred and five (27%) were operated emergently and 503 (73%) urgently. BIMA were employed in 320 (42%) patients (Group B) and isolated left IMA and/or saphenous vein grafts in the remaining 438 (58%) patients (Group M). Results: In-hospital mortality (B=5.9% and M=5.3%), and perioperative myocardial infarction (B=2.2%; M=1.96%) were similar between the two groups (P=ns). Actuarial survival at 1, 3 and 7 years was 98.7, 97.5 and 96.2% in B and 99, 94.3 and 88.4% in M (P<0.05 at 7 years follow-up). At 7 years follow-up, the event-free cardiac survival (92 vs. 87%, P=0.021), angina-free survival (98.6 vs. 94%, P=0.039), reoperation-free cardiac survival (98 vs. 95%, P=0.04) and infarct-free cardiac survival (98.7 vs. 96%, P=0.05) were better in Group B. Multivariate analysis identified age>65 years (P=0.02), LVEF<35% (P=0.01), >1 ischemic irreversible area (P=0.03) as independent predictors for late deaths, while the use of the LIMA (P=0.006) and both mammary arteries (P=0.001) decreased the risk of late deaths. Conclusions: The use of BIMA in non-elective CABG for UA is safe and effective. Mid-term outcome, however, are superior with improved freedom from cardiac death, from coronary reintervention and from myocardial infarction.

Key Words: Unstable angina • Coronary artery bypass grafting • Emergency surgery • Double mammary arteries

This article has been cited by other articles:

				M. Bonacchi, M. Maiani, and M. Leacche Reply to Raja: Why skeletonized BIMA for unstable angina? Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 781 - 781. [Full Text] [PDF]

				S. G. Raja Skeletonized bilateral internal mammary arteries in unstable angina: a paradigm shift Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 780 - 781. [Full Text] [PDF]