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International Society For Minimally Invasive Cardiothoracic Surgery

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Early Intrahospital Results of Coronary Revascularization Using Bima Composite "y" Grafts Versus Other Surgical Revascularization Techniques
Martins Erglis1, Sintija Kukaine2, Ivars Brecs1, Martins Kalejs1, Peteris Stradins1, Andrejs Erglis1
1Pauls Stradins University hospital, Riga, Latvia, 2Riga Stradins University, Riga, Latvia

BACKGROUND: Several studies have shown better long-term mortality using bilateral mammary arteries (BIMA) in coronary artery bypass grafting (CABG). Concern was raised that use of BIMA grafting is technically more demanding and could increase surgery time as well risk of sternal wound infection. There has still been debate of BIMA technical aspects to achieve full myocardial revascularization. METHODS:This is a retrospective single center study where we analyzed intraoperative and pre-discharge data between two surgical myocardial revascularization techniques. In the first group all patients who underwent CABG using BIMA as a composite graft in Y configuration as the only graft material (BIMA Y) were included. In the second group all comers in 2018 who underwent other configurations of CABG (other CABG) were included. RESULTS: There were 61 patients included in the BIMA Y group and 157 patients in the other CABG group. In the BIMA Y group there were fewer female patients - 23% compared to other CABG group - 37% (p = 0.049) and less diabetic patients (16% vs 29%, p = 0.048). We observed no significant changes in total aortic cross-clamp time (BIMA Y vs other CABG; 63.44 19.28 min and 60.0720.38 min, p = 0.96), but CPB time was shorter in the BIMA Y group (76.5723.49 min vs 81.8629.34 min). In both groups similar number of coronary anastomoses per patient were done (BIMA Y vs other CABG; 3.050.8 and 3.130.76; p = 0.11) to achieve complete revascularization. The mean total operation time was slightly longer in BIMA Y group (218.240.45 min and 176.6752.6 min) albeit not reaching statistical significance, p=0.09. There was no significant difference in deep wound infection rate (BIMA Y vs other CABG; 7% vs 5%, p = 0.56), neither in postoperative stay (10.026.90 days vs 9.996.32 days, p = 0.96).CONCLUSIONS: With using BIMA in Y configuration it is possible to achieve total arterial revascularization with no increase in aortic cross-clamp time, total CPB time and with only insignificantly longer total operative time. Our study has not shown a higher rate of deep wound infection or prolonged postoperative stay using BIMA in Y technique.


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