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OBJECTIVE:
Bilateral internal mammary artery (BIMA) bypass grafting has been associated with improved long term survival and freedom from re-intervention when compared to single IMA grafts. However, recent randomised trial data suggests an increased wound-related morbidity with BIMA harvest. We examined our experience of BIMA use in patients undergoing off-pump coronary artery bypass (OPCAB) grafting using a composite ‘T’-grafting technique
METHODS:
Between 2003 and 2010, 388 patients underwent OPCAB using BIMA conduits under the care of a single surgeon. 214 of these patients received BIMA grafts to left-sided targets using ‘T’-composite grafts of skeletonised, free Right IMA (RIMA) arising from in-situ Left IMA. LIMA grafts were applied to the LAD territory and RIMA to the other left-sided targets. Data was prospectively collected from a patient database and by questionnaire and telephonic follow up.
RESULTS:
Median follow up was 4 years and 3 months (range 11months to 8 years). Pre-operative characteristics of the patients are given in Table 1.

% Male	89.2%
% age <65y	68%
% Body Mass Index ≥ 30	42%
% Diabetes	21%
% COPD	1%
% left main stenosis >50%	38%
Mean Euroscore	2.3

Mean number of grafts per patient was 3.5. Reoperation for bleeding was required in 5 patients (2%). There was no in-hospital mortality, and overall mortality during the follow up period was 0.9% (2 patients). 15 patients (7%) reported recurrence of angina, and re-intervention was required in 6 patients (2.8%). No patients experienced deep sternal wound infections, and while 7 patients (3.3%) developed superficial sternal infection, none required surgical intervention.
CONCLUSIONS:
Off pump BIMA revascularisation of left-sided coronary vessels using a composite ‘T’-grafting configuration can be achieved with excellent post-operative wound-related outcomes, and with good medium term symptom-free survival