Does bilateral ITA grafting increase perioperative complications?☆Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass

Abstract

CABG using both ITAs can be performed routinely with good clinical results and low mortality. Compared with single ITA grafting, sternal and bleeding complications were slightly increased. Diabetes mellitus, BITA grafting, duration of surgery but not obesity or COPD could be identified as independent risk factors for sternal complications. Dialysis-dependent renal failure, EF<30%, emergent cases, and the absence of BITA grafting were predictors for increased perioperative mortality.

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

“…The long-term benefit of BIMA use is relatively low in the elderly. BIMA use may increase the risk of sternal wound infection, 23,24 especially in patients with diabetes mellitus. 25 However, other studies have shown that the skeletonization technique reduces the risk of wound infection after BIMA use in diabetic patients 26 and that BIMA grafts provide some benefits even in diabetic patients.…”

Conduit Selection for Improved Outcomes in Coronary Artery Bypass Surgery

“…After 10 years of experience with BIMA CABG, Gansera et al noted increased OR and aortic cross clamp times among BIMA patients compared with single IMA CABG patients. In addition, patients receiving BIMA grafting had higher rates of bleeding requiring postoperative mediastinal reexploration (2.9% vs. 0.6%) along with increased rates of wound complications [95]. However, they also noted that nearly one full additional distal graft was completed when both IMAs were used and, most importantly, BIMA grafting was associated with improved 30-day survival, particularly among diabetic patients, compared with only one IMA graft.…”

“…However, they also noted that nearly one full additional distal graft was completed when both IMAs were used and, most importantly, BIMA grafting was associated with improved 30-day survival, particularly among diabetic patients, compared with only one IMA graft. [95]. In this same study, a grafting strategy not incorporating 2 IMA conduits was an independent predictor of perioperative mortality, directly disputing biases that BIMA grafting is associated with increased perioperative complications [95].…”

“…[95]. In this same study, a grafting strategy not incorporating 2 IMA conduits was an independent predictor of perioperative mortality, directly disputing biases that BIMA grafting is associated with increased perioperative complications [95]. Similarly, Kurlansky et al reviewed their collective experience with more than 4,500 consecutive CABG procedures (2,369 single IMA; 2,215 BIMA) and demonstrated that hospital mortality was significantly reduced among patients undergoing BIMA grafting compared with controls [92].…”

“…At a mean follow-up of nearly 13 years, long-term survival was no different between groups [106, Figure]. Gansera et al recently described their strategy for with BIMA versus single IMA in which the RIMA was usually directed anteriorly and to the left as pedicled conduit for the LAD, while the LIMA was typically directed for revascularization of the lateral wall (circumflex artery distribution) [95]. Importantly, RIMA crossover grafts to the LAD coronary system appear to have patency rates that are not different from LIMA-LAD configurations [107].…”