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European Journal of Cardio-Thoracic Surgery, Vol 7, 287-293, Copyright © 1993 by European Association for Cardio-thoracic Surgery
R Dion, PY Etienne, R Verhelst, G Khoury, J Rubay, P Bettendorff, C Hanet and W Wyns
Between October 1985 and September 1991, 400 patients benefited from
bilateral internal mammary artery (BIMA) grafting. Of these, 354 (88.5%)
were male and the average age was 57.4 years. There were 132 (33%) urgent
procedures, 55 in diabetic patients (14%) and 15 in end- stage renal
failures (4%). An average of 3.9 distal anastomoses (AN) per patient was
undertaken, 2.8 using arterial grafts. Two hundred sixty-nine patients
(67.2%) received exclusively arterial grafts. Right internal mammary artery
(RIMA) grafts were predominantly directed to the left coronary system (348
AN = 78%) and particularly to the circumflex (CX) area. Postoperative
myocardial infarction was diagnosed in 16 patients (4%). Reoperation was
required for early myocardial ischemia in 12 patients (3%) and for
excessive bleeding in 23 patients (5.8%). Sternal complications occurred in
18 patients (4.1%), 5 in diabetic patients (9%) and 3 in renal patients
(20%). The hospital mortality was 2% (8 patients, 3 cardiac causes).
Follow-up averages 37.7 months. Late mortality was 3% (12 patients, 4
cardiac causes). Angina recurred in 12 patients (3.1%). The maximal stress
test at a mean interval of 9 months was abnormal in 7.4% (21 patients). One
hundred eighty-one patients (47%) consented to an angiographic restudy at
an average of 13 months postoperatively. Pedicled RIMA patency rates equal
those of pedicled LIMA (95.1 vs 96.7, NS) and the grafted vessel does not
alter the patency rates of IMA AN. A pedicled IMA graft is preferable to a
free IMA graft (96.1 vs 79.6, P < 0.001).(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Bilateral mammary grafting. Clinical, functional and angiographic assessment in 400 consecutive patients
Department of Cardiovascular and Thoracic Surgery, University Hospital St. Luc, Brussels, Belgium.
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