International Society For Minimally Invasive Cardiothoracic Surgery

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Skeletonized Bima Grafts In 592 Consecutive Patients. A 15-year Single-center Experience.
Enrico Ferrari, Tiziano Torre, Marc Antoine Jean-Gilles, Elena Caporali, Tiziano Cassina, Gabriele Casso, Giovanni Pedrazzini, Stefanos Demertzis.
CCT, Lugano, Switzerland.

OBJECTIVE Skeletonized bilateral mammary arteries can be routinely employed in total arterial myocardial revascularization. We retrospectively reviewed and analysed the surgical outcome of patients operated for myocardial revascularization with bilateral internal mammary artery (BIMA) grafts in a single centre during fifteen years. METHODS From January 2001 to June 2016, 592 consecutive patients received BIMA grafts. In all patients, internal mammary arteries were harvested is a skeletonized manner. BIMA were preferentially used for the revascularization of the left coronary arteries. Clinical variables were prospectively collected and retrospectively analysed. A phone-call follow-up was obtained. Univariate analysis of potential risk factors for sternal wound infection was performed with Student’s T-test. RESULTS Mean age was 61±10 years. Among them, 90% were male and the mean number of diseased coronary vessels was 2.8±0.4. Mean left ventricular ejection fraction was 58±9.2%. Hundred twenty-two patients (21%) were diabetics (18 were on insulin treatment) and 30 (5%) required combined procedures. Mean number of grafts per patient was 3.5±0.9. Mean cardiopulmonary bypass and aortic cross-clamp times were 71±44 and 45±30 minutes, respectively (18% were OPCAB). Hospital mortality was 0.5% (3 pts). With regards to postoperative complications, 3 patients had a stroke, 4 patients (0.4%) needed dialysis and 27 (4.6%) required re-thoracotomies for bleeding. There were sternal wound problems in 70 cases (11.8%) with 18 non-infected cases. Twenty one were in-hospital superficial infections (3.5%) and 1 (0.2%) was a deep infection. After discharge, 22 cases (3.7%) presented superficial infections (mean time: 10±8.8 days) and 8 (1.4%) deep infections (mean time: 19±12 days). Wound cultures were positive in 27 patients (38.6% of diseased wounds). Univariate analysis revealed statistical relationships between sternal infection and preoperative clinical conditions: presence of previous percutaneous coronary intervention (p=0.05), associate surgical procedures (p=0.07) and peripheral vascular disease (p=0.09). During follow-up, 6 patients (1.1%) died, 47 patients required percutaneous revascularization and one patient was reoperated. CONCLUSIONS Routine use of skeletonized BIMA grafts is safe with good clinical results. The risk of deep sternal wound infection was low and comparable to non-BIMA cases also in diabetic patients.


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