Bilateral internal mammary grafting may reduces mortality in women during CABG

Aims: Several studies demonstrated increased operative mortality after coronary artery bypass grafting (CABG) in women. Increased mortality in women has often been attributed to referral bias, decreased body size and to small coronary vessels. To evaluate if the use of composite bilateral internal mammary artery grafts (BIMA) as T-Graft on the left side of the Heart has an influence on reducing mortality in women after CABG.

Methods: From February 2001 to August 2006 we performed 3638 adult cardiac operations, 2562 were isolated coronary artery bypass grafting. In the same period we operated on 523 consecutive patients, 108 of them were women (25%) using BIMA as T-graft for myocardial revascularization with or without supplemental vein grafts. We analysed the results on perioperative mortality and after a follow-up time of three mounts.

Results: A total of 325 arterial anastomoses were performed using the two mammary arteries, for an average of 3.1 arterial anastomoses per patient. There were no deaths and no perioperative infarctions related to the use of the BIMA-grafts. After 3 months all patients are alive, no patient had myocardial infarction or need of new myocardial revascularization in the target area of the BIMA-grafts.

Conclusions: The use of BIMA T-grafts on the left sided coronary arteries is a safe and feasible procedure not associated with a higher risk for perioperative morbidity and mortality. Furthermore, the use of multiple composite BITA-grafts in this selectioned group of patients achieves excellent results on reducing mortality in women presented for CABG.