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Original research article
Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis
  1. Sana N Buttar1,
  2. Tristan D Yan1,2,
  3. David P Taggart3,
  4. David H Tian1,4
  1. 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
  2. 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
  3. 3 Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
  4. 4 Royal North Shore Hospital, Sydney, Australia
  1. Correspondence to David H Tian, Level 1, 75 Talavera Road, Macquarie Park, NSW 2113, Australia; drdavidtian{at}


Background A substantial body of evidence demonstrates that myocardial revascularisation using bilateral internal mammary arteries (BIMA) improves long-term survival compared with single/left internal mammary artery (LIMA) grafting. To date, limited analyses have been made regarding other short-term and long-term outcomes in BIMA strategy.

Objectives The primary aim of the present review is to update the difference in long-term survival between BIMA and LIMA grafting and to thoroughly investigate other secondary short-term and long-term clinical outcomes between these two grafting procedures.

Methods Electronic searches were performed using three databases from their inception to November 2015. Relevant studies comparing long-term survival between BIMA and LIMA grafting were identified. Data were extracted by two independent reviewers and analysed according to predefined clinical outcomes.

Results Twenty-nine observational studies were identified, with a total of 89 399 patients. Overall, BIMA cohort had significantly improved long-term survival compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04), cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in this grafting strategy. Long-term cardiac-free, myocardial infarction-free and angina-free survivals were also superior for the BIMA cohort.

Conclusions BIMA grafting is associated with enhanced overall long-term outcomes compared with LIMA grafting. While the BIMA cohort demonstrates an increased incidence of DSWI, the survival benefits and other morbidity advantages outweigh this short-term risk.

  • Internal mammary artery (IMA)
  • bilateral
  • coronary artery bypass graft (CABG)
  • survival
  • meta-analysis.

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  • Contributors SNB and DHT had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

    Study concept and design: SNB, TDY and DHT.

    Analysis and interpretation of data: SNB and DHT.

    Drafting of the manuscript: SNB.

    Critical revision of the manuscript for important intellectual content: TDY, DPT and DHT. Statistical analysis: SNB and DHT.

    Study supervision: TDY.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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