In-situ Bilateral Internal Mammary Arteries In Coronary Artery Bypass Grafting: How Far Can We Push The Limit?
Giuseppe Tavilla, MD, PhD, Md Anamul Islam, PhD, Amber Malhotra, MD, Daniel L. Beckles, MD, Ramachandra C. Reddy, MD.
Baylor Scott & White Medical Center, Temple, TX, USA.
BACKGROUND: The superiority of bilateral internal mammary artery (BIMA) over single internal mammary artery (SIMA) is unquestionable. The complexity of the procedure and fear of complications have resulted in less than 10% BIMA use. To dispel this dogma, we compared the early results of our BIMA and SIMA cases.
METHODS: Patients were obtained from November 2020 till July 2022, when we shifted our practice to the in-situ BIMA procedure for a vast majority of our cases using off-pump technique. To evaluate the impact of using BIMA over SIMA, we performed a retrospective analysis between the two study groups after matching the baseline characteristics using a propensity score matching (PSM).
RESULTS: 349 eligible patients were reviewed [61% BIMA and 98% off-pump; for perspective, in the three years prior to the study our numbers were 459 (9% BIMA and 40% off-pump)]. After PSM matching, 30-day all-cause mortality was similar (BIMA vs. SIMA: 0% vs. 1.77%, P = .497). Median length of hospital stay was similar between the BIMA and SIMA groups (5 vs. 6 days, P = .250). Median Intensive Care Unit time was similar (BIMA vs. SIMA: 47.5 vs. 51.8 hours, P =.052). Median ventilation time was significantly shorter in the BIMA group (4.4 vs. 5.3 hours, P =.043). Post-operative complication (cardiac, neurological, pulmonary, and gastro-intestinal) rates were similar between the two study groups (BIMA vs. SIMA: 41.6% vs. 48.7%, P = .285). Rates of readmission for any reason were similar (BIMA vs. SIMA: 15.9% vs. 15.9%, P = 1). Rates of readmission for deep sternal wound infection (BIMA vs. SIMA: 0% vs. 1.77%, P =.498) and for superficial sternal wound infection (BIMA vs. SIMA: 7.08% vs. 2.65%, P = .215) were similar.
CONCLUSIONS: Our data suggests that a greater rate of BIMA use in CABG is achievable without causing any significant increment in complications.
Back to 2023 ePosters