Purpose: CABG with bilateral IMA grafts (BIMA) can improve long-term results in cardiac morbidity
and mortality. An enhanced incidence of bleeding and wound complications compared
to patients with single IMA (SIMA) remains a matter of debate. The aim of the study
was to compare the operative outcomes of patients who had undergone CABG with BIMA
and SIMA in situ grafts, especially to identify patient-related risk factors, such as obesity, diabetes
mellitus and age above 70 years. Methods: Out of a total of 5,144 patients operated on between January 1996 and September
1999, patients with isolated CABG (n = 3,671) with BIMA or SIMA were analyzed retrospectively.
In the BIMA group, the patients' (n = 1,487) mean age was 64.0 years; mean EF was
62.1 %. In the SIMA group (n = 2,184), the mean age was 65.4 years and mean EF 60.6
% (n. s.). In the BIMA group, the right IMA was anterior of the aorta to the LAD,
the left IMA to the lateral wall. In the SIMA group, the LAD was revascularisized
with the left IMA. Additional bypasses were performed with vein grafts. Results: The 30-day lethality was 1.6 % in the BIMA group, 1.7 % in the SIMA group in patients
under 70, and 4.1 % (BIMA) and 4.0 % (SIMA) in patients over 70 (p = n. s.). A
significantly higher blood loss was observed in the BIMA group (BIMA 979 ± 708 ml,
SIMA 790 ± 575 ml, p < 0.05). The rethoracotomy rate due to bleeding was significantly
higher in patients with BIMA (4.1 %) compared to those with SIMA (2.5 %, p < 0.05).
In patients with a body mass index (BMI) of less than 27, no significant difference
could be found (SIMA 2.8 %, BIMA 3.4 %, p = n. s.). Patients with a BMI > 27 showed
a significantly higher rethoracotomy rate (SIMA 2.2 %, BIMA 4.9 %). A higher incidence
of sternal instabilities could be observed in the BIMA group (4.2 %, p < 0.05). Diabetes mellitus could not be identified as an independent risk factor
for sternal complications (SIMA 2.9 %, BIMA 5.0 %, p = n. s.). Couclusion: CABG using both IMA's can be performed in nearly all patients as a routine method
with good clinical results and low mortality. Bleeding in the BIMA group within 48
hours was increased. BMI > 27 could be identified as a risk factor for sternal complications,
but not diabetes mellitus or age over 70 years.
Key words:
Coronary artery disease - Arterial revascularization - Bilateral JMA grafting
References
1 Presented at the 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and
Cardiovascular Surgery, February 9 - 12, 2000 Lucerne
