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Editorial
Bilateral internal mammary artery grafting: are BIMA better?
  1. D P Taggart
  1. Correspondence to:
    Mr David P Taggart, Cardiothoracic Department, The John Radcliffe Hospital, Oxford OX3 9DU, UK;
    david.taggart{at}orh.nhs.uk

https://doi.org/10.1136/heart.88.1.7

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    Current evidence supports a policy of increasing use of arterial grafts during CABG, in particular bilateral internal mammary arteries

    The clinical and prognostic benefits of coronary artery bypass grafting (CABG) are well accepted for certain subgroups of patients with ischaemic heart disease,1 and as many as one million patients undergo this operation annually on a worldwide basis. Most CABG patients require grafting of the three main native coronary arteries; for the last 15 years the “standard” operation has achieved this using a single internal mammary artery (SIMA) and supplemental vein grafts performed with cardiopulmonary bypass. Although this procedure achieves excellent short and medium term outcome, and over 70% of patients are alive 12 years after surgery,2 the long term results are limited by progressive vein graft failure.3 Off pump coronary artery bypass (OPCAB) surgery and the increasing use of arterial conduits are now changing the nature of the standard CABG. This article reviews evidence for the routine use of bilateral internal mammary artery (BIMA) grafts in CABG patients.

    EVIDENCE FOR SINGLE INTERNAL MAMMARY ARTERY GRAFTS

    Large observational studies, 4,5 rather than randomised trials, have established the internal mammary artery (IMA) as the “gold standard” graft in CABG. These studies have shown that the use of an IMA graft to the left anterior descending (LAD) coronary artery improves survival and reduces the incidence of late myocardial infarction, recurrent angina, and the need for further cardiac interventions.1,4,5 The evidence is so persuasive that in the UK over 90% of CABG patients now receive a SIMA graft.6

    EVIDENCE FOR BILATERAL INTERNAL MAMMARY ARTERY GRAFT

    There have been no randomised trials comparing SIMA and BIMA grafts. Nevertheless, the possibility that BIMA grafts may offer additional clinical and survival benefits to that observed with a SIMA graft has been addressed in several observational studies over the last decade (reviewed in Taggart …

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