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The use of bilateral internal mammary arteries in the revascularization of high risk patients
Objective: To assess the use of Bilateral Internal Mammary Arteries (BIMA) in high risk patients having EuroSCORE (ES) ≥6.
Methods: From cohorts of 11254 patients operated upon in Heart Institute Lahr for primary isolated multivessel coronary bypass operations between 1996 and 2008, 2 propensity matched groups of patients with ES ≥6 who received either single internal mammary artery and saphenous vein grafts (SIMA group with 160 patients) or bilateral internal mammary arteries (BIMA group with 161 patients) were studied. Preoperative data were comparable regarding age (73.8±6.25 vs. 72.8±6.79 years (p=0.19)), female sex (41.2% vs. 37.2% (p=0.47)), Body Mass Index (BMI) (26.9±3.98 vs. 27.67±3.49Kg/m2 (p=0.08)), Diabetes Mellitus (31.2% vs. 39.1% (p=0.14)), Euro score (7.33±1.49 vs. 7.24±1.47 (p=0.57)), serum creatinine (1.19±0.38 vs. 1.21±0.48mg/dl (p=0.68)), and ejection fraction (54.2±13.9% vs. 55.2±14.6% (p=0.50)).
Results: No significant difference was noticed between the two groups regarding the number of peripheral anastomoses (3.01±0.78 vs. 3.09±0.88 (p=0.39)), total operation time (191.6±55.7 vs. 202.3±47.4min. (p=0.07)), stroke (0.6% vs. 0% (p=0.32)), post operative myocardial infarction (4.3% vs. 1.8% (p=0.19)), post operative blood loss (885.1±808.3 vs. 942.8±722.8ml (p=0.51)), rethoracotomy (2.5% vs. 1.2% (p=0.41)), deep wound infection (1.9% vs. 4.3% (p=0.20)) and 30 days mortality (1.9% vs. 2.5% (p=0.71)).
Conclusion: The use of BIMA in the revascularization of high risk patients is not associated with increased risk of short term complications.