Bilateral internal mammary artery bypass grafting: long-term clinical benefits in a series of 1000 patients
- Batric Popovic1,
- Damien Voillot1,
- Pablo Maureira2,
- Fabrice Vanhuyse2,
- Nelly Agrinier3,
- Etienne Aliot1,
- Thierry Folliguet2,
- Jean Pierre Villemot2
- 1Département de Cardiologie, CHU Nancy, Nancy, France
- 2Service de Chirurgie des Maladies Cardiovasculaires et Transplantations, CHU Nancy, Nancy, France
- 3Epidémiologie et Evaluation Cliniques, CHU Nancy, Nancy, France
- Correspondence to Dr Batric Popovic, Département Cardiologie, CHU Nancy, rue de Morvan, Vandoeuvre les Nancy 54500, France;
- Received 11 December 2012
- Revised 25 February 2013
- Accepted 26 February 2013
- Published Online First 20 March 2013
Objective Bilateral internal mammary arteries (BIMA) remain widely underused in coronary artery bypass grafting (CABG). In this study, we aim to investigate the early and long-term outcomes of BIMA grafts in isolated CABGs.
Design Single-centre retrospective observational study.
Setting University Hospital, Nancy.
Patients 1000 consecutive patients undergoing elective, isolated, primary, multiple CABGs using BIMA grafts and supplemental venous grafts for multi-vessel coronary disease.
Main outcome measures In-hospital mortality and major morbidity, and long-term all-cause mortality.
Results Mean age of the overall population was 60±15 years. A left ventricular ejection fraction (LVEF) ≤45% was found in 28% of the patients and 27.1% of the patients were diabetics. Comorbidities were represented by chronic renal failure, chronic obstructive pulmonary disease and peripheral artery disease in 11, 11.7 and 27.3% of the cases, respectively. The in-hospital mortality rate was 2.8%. Early postoperative morbidity included myocardial infarction (2.2%), stroke (0.9%), mesenteric ischaemia (0.7%) and mediastinitis (2.2%).
The Kaplan–Meier 8-year survival rates for patients less than 65 and between 65 and 74 years of age were 88% and 66%, respectively (p<0.01). Multiple regression analysis showed that patients’ age 65 years or greater at baseline (OR 2.3; 95% CI 1.3 to 4, p<0.001), acute coronary syndrome (OR 1.9; 95% CI 1.1 to 3.4, p=0.02), chronic renal failure (OR 2.7; 95% CI 1.4 to 5.2, p<0.001), peripheral artery disease (OR 3.1; 95% CI 1.8 to 5.5, p<0.001) and LVEF ≤45% (OR 2.6; 95% CI 1.4 to 4.5, p<0.001) were independent predictors of long-term cardiovascular mortality.
Conclusions Our longitudinal analysis presents encouraging data concerning operative risk of BIMA grafting and provides excellent long-term survival in appropriately selected patients.