Using the Bilateral Internal Mammary Artery in the Left or Right Coronary Artery System: 5-Year Comparison of Operation Techniques and Angiographic Results

Authors

  • Mehmet Erdem Toker
  • Suat Nail Ömeroglu
  • Kaan Kirali
  • Mehmet Balkanay
  • Cevat Yakut

DOI:

https://doi.org/10.1532/HSF98.20051165

Abstract

Objective. Using the bilateral internal mammary artery (IMA) in coronary artery bypass grafting (CABG) surgery has prolonged survival, improved functional capacity, and reduced the rate of reintervention without increasing postoperative early morbidity and mortality.

Methods. Between January 1996 and December 1997, 94 CABG operations were performed using the bilateral IMA. In Group A (n = 45), the right IMA was anastomosed to the left coronary artery system; in Group B (n = 49), the right IMA was anastomosed to the right coronary artery system. The left IMA was always anastomosed to the left coronary artery system in both groups.

Results. There was 1 death (Group A) (1.06%), and 1 late death (Group B) (1.07%). One patient in Group A underwent balloon angioplasty, and 1 patient in Group B underwent reoperation after the follow-up. Pre- and postoperative data were similar between both groups, except for off-pump CABG, which was higher in Group B (2.2% versus 36.7%; P <.001). Twenty-three randomized patients in each group underwent control angiography until May 2002. Angiographic results showed that the patency of the right IMA to the right or left coronary artery system was similar (78.26% versus 82.6%; P = .7). But the left IMA had a better patency rate than the right IMA (95.65% versus 80.43%; P = .02). The patency rates of the left and right IMA anastomosis on the beating heart in Group B were not significantly different (92.3% versus 76.9%; P = .27). The patency of right IMA anastomosis with or without off-pump technique in Group B was similar (76.9% versus 80%; P = .84).

Conclusions. Bilateral IMA can be used with low morbidity and mortality. The angiographic and clinical results of off-pump CABG show that bilateral IMA can also be used in off-pump surgery with similar results.

References

Ura M, Sakata R, Nakayama Y, Arai Y, Saito T. 2000. Long-term results of bilateral internal thoracic artery grafting. Ann Thorac Surg 70:1991-6.nAshraf SS, Shaukat N, Akhtar K, et al. 1994. A comparison of early mortality and morbidity after single versus bilateral internal mammary artery grafting with the free right internal mammary artery. Br Heart J 72:321-6.nBerreklouw E, Rademakers PPC, Koster JM, van Leur L, van der Wielen BJW, Westers P. 2001. Better ischemic event-free survival after two internal thoracic artery grafts: 13 years of follow-up. Ann Thorac Surg 72:1535-41.nBuche M, Schroeder E, Chenu P, et al. 1995. Revascularization of the circumflex artery with the pedicled right internal thoracic artery: clinical functional and angiographic midterm results. J Thorac Cardiovasc Surg 110:1338-43.nBuxton BF, Reungsakulrach P, Fuller J, Rosalion A, Reid CM, Tatoulis J. 2000. The right internal thoracic artery graft-benefits of grafting the left coronary system and native vessels with a high grade stenosis. Eur J Car-diothorac Surg 18:255-61.nCalafiore AM, Teodori G, Giammarca GD, et al. 1999. Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg 67:450-6.nOmeroglu SN, Kirali K, Güler M, et al. 2000. Mid-term angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 70:844-9.nKnapik P, Spyt TJ, Richardson JB, McLennan I. 1996. Bilateral and unilateral use of internal thoracic artery for myocardial revascularization. Comparison of extubation outcome and duration of hospital stay. Chest 109:1231-3.nEndo M, Nishida H, Tomizawa Y, Kasanuki H. 2001. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation 104:2164-70.nSchmidt SE, Jones JW, Thornby JI, Miller III CC, Beall AC Jr. 1997. Improved survival with multiple left-sided bilateral internal thoracic artery grafts. Ann Thorac Surg 64:9-15.nFiore AC, Naunheim KS, Dean P, et al. 1990. Results of internal thoracic artery grafting over 15 years: single versus double grafts. Ann Thorac Surg 49:202-9.nGerola LR, Puig LB, Moreira LFP, et al. 1996. Right internal thoracic artery through the transverse sinus in myocardial revascularization. Ann Thorac Surg 61:1708-13.nTatoulis J, Buxton BF, Fuller JA, Royse AG. 1999. Total arterial coronary revascularization: techniques and results in 3,220 patients. Ann Thorac Surg 68:2093-9.nIoannidis JP, Galanos O, Katritsis D, et al. 2001. Early mortality and morbidity of bilateral versus single internal thoracic artery revasculariza-tion: propensity and risk modeling. J Am Coll Cardiol 37:521-8.nDietl CA, Benoit LH, Gilbert CL, et al. 1995. Which is the graft of choice for the right coronary and posterior descending arteries? Comparison of the right internal mammary artery and the right gastroepiploic artery. Circulation 92(Suppl II):92-7.nAscione R, Underwood MJ, Lloyd CT, Jeremy JY, Bryan AJ, Angelini GD. 2001. Clinical and angiographic outcome of different surgical strategies of bilateral internal mammary artery grafting. Ann Thorac Surg 72:959-65.nDewar LRS, Jamieson WRE, Janusz MT, et al. 1995. Unilateral versus bilateral internal mammary revascularization, survival and event-free performance. Circulation 92(Suppl II);8-13.nPick AW, Orszulak TA, Anderson BJ, Schaff HV. 1997. Single versus bilateral internal mammary artery grafts: 10-year outcome analysis. Ann Thorac Surg 64:599-605.nLytle BW, Blackstone EH, Loop FD, et al. 1999. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855-72.nLytle BW, Loop FD. 2001. Superiority of bilateral internal thoracic artery grafting. Circulation 104:2152-4.nKirali K, Daglar B, Güler M, et al. 1999. Experiences of Kosuyolu in minimally invasive coronary artery surgery. Turkish J Thorac Cardiovasc Surg 7:25-9.nHe GW, Ryan WH, Acuff TE, et al. 1994. Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting. J Thorac Cardiovasc Surg 107:196-202.nKirali K, Rabus MB, Yakut N, et al. 2002. Early- and long-term comparison of the on- and off-pump bypass surgery in patients with left ventricular dysfunction. Heart Surg Forum 5:177-81.nTaggart DP. 2000. Respiratory dysfunction after cardiac surgery: effects of avoiding cardiopulmonary bypass and the use of bilateral internal mammary arteries. Eur J Cardiothorac Surg 18:31-7.nToker ME, Kirali K, Guler M, et al. 2000. The use of bilateral internal mammarian artery for coronary artery revascularization: mid-term results. T Klin J Cardiovasc Surg 1:13-8.nJones JW, Schmidt SE, Miller R, Nahas C, Beall AC Jr. 1997. Suitability and durability of multiple internal thoracic artery coronary artery bypasses. Ann Surg 225:785-92.nChow MST, Sim E, Orszulak TA, Schaff HV. 1994. Patency of internal thoracic artery grafts: comparison of right versus left and importance of vessel grafted. Circulation 90(part 2):129-32.n

Published

2005-11-11

How to Cite

Toker, M. E., Ömeroglu, S. N., Kirali, K., Balkanay, M., & Yakut, C. (2005). Using the Bilateral Internal Mammary Artery in the Left or Right Coronary Artery System: 5-Year Comparison of Operation Techniques and Angiographic Results. The Heart Surgery Forum, 8(6), E462-E467. https://doi.org/10.1532/HSF98.20051165

Issue

Section

Articles

Most read articles by the same author(s)