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DOI: 10.1055/s-0040-1705344
Comparison of Short-Term Clinical Results of Double versus Single Internal Mammary Artery Bypass Grafting in Three Different Age Groups
Publication History
Publication Date:
13 February 2020 (online)
Objectives: The benefits of using double internal mammary artery in coronary bypass grafting in young patients are well known. Regarding elderly patients though, those benefits are still not proven.
Methods: A total of 10,729 patients, who underwent primary and isolated CABG in our department, were studied retrospectively over 15 years (January 2004–June 2019) to compare the outcomes of three subgroups: no mammary (nIMA), single-internal mammary (sIMA) and double internal mammary (dIMA) in three age groups: under 60, between 60 and 75, and older than 75 years.
Result:
|
Count of patient |
BMI |
Count of Anastomoses |
OP time |
Wound revision |
Log. Eurosocore |
Perioperative mortality |
|
|---|---|---|---|---|---|---|---|
|
<60 y |
2,294 |
28.9 |
2.6 |
202 |
3.9% |
1.7% |
1.6% |
|
nIMA |
73 |
29.3 |
1.8 |
173 |
0.0% |
3.1% |
9.6% |
|
sIMA |
918 |
29.2 |
2.3 |
180 |
2.4% |
2.0% |
2.9% |
|
dIMA |
1,303 |
28.7 |
2.8 |
219 |
5.1% |
1.4% |
0.2% |
|
60 to 75 y |
5,373 |
28.2 |
2.6 |
199 |
3.4% |
3.0% |
2.8% |
|
nIMA |
261 |
28.6 |
2.0 |
197 |
1.9% |
5.8% |
11.9% |
|
sIMA |
2,593 |
28.3 |
2.5 |
183 |
1.9% |
3.4% |
3.6% |
|
dIMA |
2,519 |
28.1 |
2.7 |
216 |
5.1% |
2.2% |
1.0% |
|
>75 y |
3,062 |
27.4 |
2.5 |
196 |
3.7% |
6.1% |
4.9% |
|
nIMA |
160 |
27.1 |
2.0 |
194 |
2.5% |
11.2% |
18.8% |
|
sIMA |
1,857 |
27.5 |
2.4 |
182 |
2.0% |
6.4% |
5.1% |
|
dIMA |
1,045 |
27.1 |
2.6 |
220 |
6.8% |
4.7% |
2.5% |
|
Total |
10,729 |
28.1 |
2.5 |
199 |
3.6% |
3.6% |
3.2% |
Even after considering the selection bias (seen by lower Euroscores), using dIMA was associated with significant lower perioperative mortalities in all age groups (p < 0.0001). Ventilation time und ICU stay were also shorter (p = 0.027 and 0.018). Though, skin-to-skin time was almost 20 minutes longer (p = 0.008) and wound revision rate was higher (p < 0.0001).
Conclusion: Using dIMA in CABG can improve perioperative survival rates in all age groups. Though this surgery requires more operation time and has higher wound revision rates, elderly patients should not automatically be excluded from a dIMA-procedure. The decision has to be made individually based on other factors such as BMI and the coronary complexity.