Bilateral internal mammary artery grafting in women: A 21-year experience

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…[1162][1163][1164][1165] Lastly, the operative procedure itself appears to be different in women than in men, in that women are less likely to be completely revascularized 1166,1167 and less likely to have IMA grafting, especially bilateral, 1168 although bilateral IMA grafting in women is associated with low rates of in-hospital morbidity and mortality. 1169 …”

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

“…The most important surgical gain has been verification of excellent late patency with IMA grafts (74). From this encouraging result with the use of a single arterial graft has sprung the arterial arborization of today, with reports of multiple and "complete" arterial grafting (75)(76)(77)(78). This is discussed further in Sections 4.2. and 6.2.…”

“…IMA grafts have been reported to be used less often in women, possibly contributing to a higher mortality (25,486). Kurlansky et al (78) reported favorable results in 327 women with bilateral IMA grafts plus supplemental vein grafts, with a hospital mortality of 3% to 4%, low postoperative morbidity, excellent functional improvement, and enhanced longterm survival. Five-year survival of 90.5% and of 65.6% at 10 years was achieved, with 94% of patients reaching NYHA Class I and 4.5% NYHA Class II.…”

“…These include MI, stroke, reoperation for bleeding, pulmonary insufficiency, renal insufficiency, sternal wound infection (perhaps related to obesity), CHF, rhythm other than normal sinus rhythm, and low cardiac output syndrome (25,78,490). Women appear particularly vulnerable to postoperative CHF, low cardiac output syndrome (25,29,482), and blood loss (485).…”

Is there any further advantage of using more than one internal mammary artery? Literature review and analysis

“…In a longitudinal study of BIMA in women, Kurlansky and colleagues 18 showed that the actuarial survival (mean AE standard error of the mean) was 90.5% AE 1.9% at 5 years and 65.6% AE 6.1% at 10 years. Calafiore and colleagues 19 showed 99% patency of the two IMA during angiographic studies at 18 months.…”