Hospital Volume and Outcome after Bilateral Internal Mammary Artery Grafting

Authors

  • Andrea Perrotti Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
  • Daniel Reichart Hamburg University Heart Center, Hamburg, Germany
  • Giuseppe Gatti Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
  • Giuseppe Faggian Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
  • Francesco Onorati Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
  • Marisa De Feo Division of Cardiac Surgery, Universita degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
  • Sidney Chocron, MD Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
  • Magnus Dalén Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  • Giuseppe Santarpino Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany and Città di Lecce Hospital GVM Care&Research, Lecce, Italy
  • Antonino S. Rubino Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Pedara, Italy
  • Daniele Maselli Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
  • Riccardo Gherli Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
  • Antonio Salsano Division of Cardiac Surgery, University of Genoa, Genoa, Italy
  • Francesco Nicolini Division of Cardiac Surgery, University of Parma, Parma, Italy
  • Marco Zanobini Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, University of Milan, Milan, Italy
  • Karl Bounader Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
  • Stefano Rosato National Center of Global Health, Istituto Superiore di Sanità, Rome, Italy
  • Tuomas Tauriainen Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
  • Tatu Juvonen Heart Center, Helsinki University Hospital, Finland
  • Giovanni Mariscalco Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
  • Vito G. Ruggieri Division of Cardiac Surgery, Reims University Hospital, Reims, France; 20Heart Center, Turku University Hospital, and Department of Surgery, University of Turku, Turku, Finland
  • Fausto Biancari Heart Center, Turku University Hospital, and Department of Surgery, University of Turku, Turku, Finland

DOI:

https://doi.org/10.1532/hsf.2745

Keywords:

Coronary artery bypass grafting, bilateral, internal mammary artery, sternal wound infection

Abstract

Background: Bilateral internal mammary artery (BIMA) grafting largely is underutilized in patients undergoing coronary artery bypass grafting (CABG), partly because of the perceived increased complexity of
the procedure.

Aims: In this study, we evaluated whether BIMA grafting can safely be performed also in centers, where this revascularization strategy infrequently is adopted.

Methods: Out of 6,783 patients from the prospective multicenter E-CABG study, who underwent isolated non-
emergent CABG from January 2015 to December 2016, 2,457 underwent BIMA grafting and their outcome was evaluated in this analysis.

Results: The mean number of BIMA grafting per center was 82 cases/year and hospitals were defined as high or low volume, according to this cutoff value. Six hospitals were considered as centers with a high volume of BIMA grafting (no. of procedures ranging from 120 to 267/year; overall: 2,156; prevalence: 62.2%) and nine hospitals as centers with a low volume of BIMA grafting (no. of procedures ranging from 2 to 39/year; overall: 301; prevalence: 9.1%). Multilevel mixed-effects regression analysis showed that the low- and high-volume cohorts had similar outcomes. Propensity score one-to-one matching analysis of 292 pairs showed that the low-volume cohort had a significantly shorter intensive care unit stay (2.2 ± 2.3 versus 2.9 ± 4.8 days, P = .020). The rates of in-hospital death (1.0% versus 0.3%, P = .625), deep sternal wound infection/mediastinitis (3.8% versus 3.1%, P = .824), and 1-year survival (98.1% versus 99.7%, P = .180) as well as other outcomes were similar between the high- and
low-volume cohorts.

Conclusions: BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently performed.

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Published

2020-07-08

How to Cite

Perrotti, A., Reichart, D., Gatti, G., Faggian, G., Onorati, F., De Feo, M., Chocron, S., Dalén, M., Santarpino, G., Rubino, A. S., Maselli, D., Gherli, R., Salsano, A., Nicolini, F., Zanobini, M., Bounader, K., Rosato, S., Tauriainen, T., Juvonen, T., Mariscalco, G., G. Ruggieri, V., & Biancari, F. (2020). Hospital Volume and Outcome after Bilateral Internal Mammary Artery Grafting. The Heart Surgery Forum, 23(4), E475-E481. https://doi.org/10.1532/hsf.2745

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Section

Articles