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OBJECTIVE: Many studies suggest better outcome after coronary artery bypass surgery (CABG) using arterial grafts, especially bilateral internal mammary arteries (BIMA). Using composite arterial grafts with bilateral internal mammaries provide the optimal technique. In this study we evaluate the efficacy of multiple composite graft with BIMA to bypass coronary arteries without sequential technique which is supposed to induce flow disturbance in graft.
METHODS: From April 2006 to May 2007, 23 patients younger than 55 years old with ejection fraction (EF) ≥40% underwent CABG using SKT-BIMA. Both mammary arteries were harvested with skeletonization technique. Right-IMA (RIMA) was harvested in its full length and was cut in different lengths, and anastomosed to left-IMA (LIMA) which was connected to its pedicle. We used Radial artery to incorprate more branches if necessary. Graft patency and flow abnormalities were examined with functional angiography in all of the patients in 8-12 weeks interval.
RESULTS: Short term clinical outcomes were excellent and there was no mortality. Echocardiographic evaluations of the patients, showed 3.4% increase in EF (p-value <0.05). Among 94 distal anastomoses in all patients, 66 of which (70.2%) were with mammary arteries, the most common performed patterns were К( kappa) (11 patients), Λ (lambda) (3 patients) and double mini-composite (3 patients). Post operative functional angiography showed angiography-defined string sign in 1 mammary graft (1.5%), total graft occlusion in 1 mammary graft (1.5%) and competitive blood flow in 4 mammary grafts (6%).
CONCLUSIONS: Short term patency of multiple composite arterial grafts using SKT-BIMA technique in CABG was excellent, proved to have low flow disturbances and acceptable clinical results .