Early outcome of coronary artery bypass graft surgery using bilateral internal mammary artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANG Yi ,  WANG Xiaoqi , ZHENG Zhe , FAN Hongguang , LI Haojie , HOU Jianfeng , GAO Ge

Department of Surgery, Fu Wai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100037, P.R. China;

Corresponding author：

WANG Xiaoqi, Email: wxqfwn@163.com

Keywords：

Coronary artery bypass graft; internal mammary arteries; pulsatility index

DOI：

10.7507/1007-4848.201608081

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the safety, efficacy of the surgery and the characteristics of the blood flow after coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA) to analyze the early operative results, CT results and the graft flow. Methods From December 2015 to July 2016, 52 patients (46 males, 6 females) with an average age of 56.6±6.8 years, underwent CABG using bilateral internal mammary artery. All the operations were carried out under extracorporeal circulation, both internal mammary arteries were obtained with pedicle and the bypass path was designed according to the target vessels. After the anastomosis was completed, the graft flow was measured using Veri Q system. The CT angiography of coronary artery was completed before discharge. Perioperative outcomes, early CT outcomes, and blood flow of grafts were analysed. Results There was no operative mortality. The average operation time was 4.7±0.6 hours, average cardiopulmonary bypass time was 114.8±20.6 minutes, average cross-clamping time was 82.8±17.6 minutes, average mechanical ventilation time was 17.6±10.5 hours and average ICU stay was 2.7±1.8 days. The mean number of distal anastomosis was 4.6±0.8. One patient suffered sternal complication and poor wound healing and then receieved debridement as well as suturing. Other patients discharged without surgical complications. The average flow of left internal mammary artery (LIMA) graft was 28.1±11.4 ml/min with a mean pulsatility index (PI) of 2.2±0.6. The average flow of right internal mammary artery (RIMA) was 27.3±12.0 ml/min with a mean PI of 2.4± 0.8. The mean flow of great saphenous vein was 41.5±21.5 ml/min with a mean PI of 2.2±0.7. There was no significant difference in the mean flow between LIMA and RIMA (P=0.978). The mean flow of the great saphenous vein was significantly higher than that of RIMA and LIMA (P=0.000). CT angiography showed no stenosis. Distal anastomosis of 7 vein grafts and 5 artery grafts was demonstrated shallow in CT angiography and 2 vein grafts were undemonstrated, suggesting occlusion. Conclusion The use of BIMA for CABG is safe with less complications. RIMA flow is equivalent to LIMA flow. RIMA with no stenosis and occlusion of artery grafts in the early stage, therefore is the ideal and stable coronary bypass graft.

Citation： CHANG Yi, WANG Xiaoqi, ZHENG Zhe, FAN Hongguang, LI Haojie, HOU Jianfeng, GAO Ge. Early outcome of coronary artery bypass graft surgery using bilateral internal mammary artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 206-210. doi: 10.7507/1007-4848.201608081 Copy

1.	Mohr FW, Davierwala PM. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2014, 46(4): 517-592.
2.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
3.	Barner HB, Swartz cMT, Mudd JG, et al. Late patency of the internal mammary artery as a coronary bypass conduit. Ann Thorac Surg, 1982, 34(4): 408-412.
4.	Bourassa MG. Fate of venous grafts: The past, the present and the future. J Am Coll Cardiol, 1991, 17(5): 1081-1083.
5.	Buxton BF, Shi WY, Tatoulis J, et al. Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival. J Thorac Cardiovasc Surg, 2014, 148(4): 1238-1243.
6.	Locker C, Schaff HV, Dearani JA, et al. Multiple arterial grafts improve late survival of patients undergoing coronaryartery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation, 2012, 126(9): 1023-1030.
7.	Zacharias A, Schwann TA, Riordan CJ, et al. Late results of conventional versus all-arterial revascularization based on internalthoracic and radial artery grafting. Ann Thorac Surg, 2009, 87(1): 19-26.
8.	Kelly R, Buth KJ, Légaré JF. Bilateral internal thoracic artery grafting is superior to other forms of multiple arterial grafting in providing survival benefit after coronary bypass surgery. J Thorac Cardiovasc Surg, 2012, 144(6): 1408-1415.
9.	Shi WY, Hayward PA, Tatoulis J, et al. Are all forms of total arterial revascularization equal? A comparison of single versus bilateral internal thoracic artery grafting strategies. J Thorac Cardiovasc Surg, 2015, 150(6): 1526-1533.
10.	Dimitrova KR, Hoffman DM, Geller CM, et al. Arterial grafts protect the native coronary vessels from atherosclerotic disease progression. Ann Thorac Surg, 2012, 94(2): 475-481.
11.	Boodhwani M, Nathan HJ, Lam BK, et al. The internal thoracic artery skeletonization study: A paired, within-patient comparison. Trials, 2006, 7: 1.
12.	Boodhwani M, Lam BK, Nathan HJ, et al. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blind, within-patient comparison. Circulation, 2006, 114(8): 766-773.
13.	Deja MA, Wos S, Golba KS, et al. Intraoperative and laboratory evaluation of skeletonized versus pedicled internal thoracic artery. Ann Thorac Surg, 1999, 68(6): 2164-2168.
14.	Benedetto U, Altman DG, Gerry S, et al. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg, 2016, 152(1): 270-276.
15.	Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg, 1996, 111(6): 1200-1207.
16.	Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med, 2001, 345(11): 790-797.
17.	Cosgrove DM, Lytle BW, Loop FD, et al. Does bilateral internal mammary artery grafting increase surgical risk? J Thorac Cardiovasc Surg, 1988, 95(5): 850-856.
18.	Leung Wai Sang S, Chaturvedi R, Alam A, et al. Preoperative hospital length of stay as a modifiable risk factor for mediastinitis after cardiac surgery. J Cardiothorac Surg, 2013, 8: 45.
19.	Jeong DS, Sung K, Lee YT, et al. Pure bilateral internal thoracic artery grafting in diabetic patients with triple-vessel disease. Ann Thorac Surg, 2015, 100(6): 2190-2197.
20.	Kurlansky PA, Traad EA, Dorman MJ, et al. Location of the second internal mammary artery graft does not influence outcome of coronary artery bypass grafting. Ann Thorac Surg, 2011, 91(5): 1378-1383.
21.	Silber S, Finsterer S, Krischke I, et al. Noninvasive angiography of coronary byp ass grafts w ith cardio-CT in a cardiology practice. Herz, 2003, 28(2): 126-135.
22.	高长青, 张涛, 李伯君, 等. 冠状动脉旁路移植术大隐静脉桥的平均流量及影响因素分析. 中华外科杂志, 2006, 44(2): 80-82．.
23.	Cetin SM, Massoudy P, Thielmann M, et al. Intraoperative coronary graft flow determination--does it have a prognostic value for midterm graft patency. Eur J Med Res, 2006, 31(7): 267-272.

1. Mohr FW, Davierwala PM. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2014, 46(4): 517-592.
2. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
3. Barner HB, Swartz cMT, Mudd JG, et al. Late patency of the internal mammary artery as a coronary bypass conduit. Ann Thorac Surg, 1982, 34(4): 408-412.
4. Bourassa MG. Fate of venous grafts: The past, the present and the future. J Am Coll Cardiol, 1991, 17(5): 1081-1083.
5. Buxton BF, Shi WY, Tatoulis J, et al. Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival. J Thorac Cardiovasc Surg, 2014, 148(4): 1238-1243.
6. Locker C, Schaff HV, Dearani JA, et al. Multiple arterial grafts improve late survival of patients undergoing coronaryartery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation, 2012, 126(9): 1023-1030.
7. Zacharias A, Schwann TA, Riordan CJ, et al. Late results of conventional versus all-arterial revascularization based on internalthoracic and radial artery grafting. Ann Thorac Surg, 2009, 87(1): 19-26.
8. Kelly R, Buth KJ, Légaré JF. Bilateral internal thoracic artery grafting is superior to other forms of multiple arterial grafting in providing survival benefit after coronary bypass surgery. J Thorac Cardiovasc Surg, 2012, 144(6): 1408-1415.
9. Shi WY, Hayward PA, Tatoulis J, et al. Are all forms of total arterial revascularization equal? A comparison of single versus bilateral internal thoracic artery grafting strategies. J Thorac Cardiovasc Surg, 2015, 150(6): 1526-1533.
10. Dimitrova KR, Hoffman DM, Geller CM, et al. Arterial grafts protect the native coronary vessels from atherosclerotic disease progression. Ann Thorac Surg, 2012, 94(2): 475-481.
11. Boodhwani M, Nathan HJ, Lam BK, et al. The internal thoracic artery skeletonization study: A paired, within-patient comparison. Trials, 2006, 7: 1.
12. Boodhwani M, Lam BK, Nathan HJ, et al. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blind, within-patient comparison. Circulation, 2006, 114(8): 766-773.
13. Deja MA, Wos S, Golba KS, et al. Intraoperative and laboratory evaluation of skeletonized versus pedicled internal thoracic artery. Ann Thorac Surg, 1999, 68(6): 2164-2168.
14. Benedetto U, Altman DG, Gerry S, et al. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg, 2016, 152(1): 270-276.
15. Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg, 1996, 111(6): 1200-1207.
16. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med, 2001, 345(11): 790-797.
17. Cosgrove DM, Lytle BW, Loop FD, et al. Does bilateral internal mammary artery grafting increase surgical risk? J Thorac Cardiovasc Surg, 1988, 95(5): 850-856.
18. Leung Wai Sang S, Chaturvedi R, Alam A, et al. Preoperative hospital length of stay as a modifiable risk factor for mediastinitis after cardiac surgery. J Cardiothorac Surg, 2013, 8: 45.
19. Jeong DS, Sung K, Lee YT, et al. Pure bilateral internal thoracic artery grafting in diabetic patients with triple-vessel disease. Ann Thorac Surg, 2015, 100(6): 2190-2197.
20. Kurlansky PA, Traad EA, Dorman MJ, et al. Location of the second internal mammary artery graft does not influence outcome of coronary artery bypass grafting. Ann Thorac Surg, 2011, 91(5): 1378-1383.
21. Silber S, Finsterer S, Krischke I, et al. Noninvasive angiography of coronary byp ass grafts w ith cardio-CT in a cardiology practice. Herz, 2003, 28(2): 126-135.
22. 高长青, 张涛, 李伯君, 等. 冠状动脉旁路移植术大隐静脉桥的平均流量及影响因素分析. 中华外科杂志, 2006, 44(2): 80-82．.
23. Cetin SM, Massoudy P, Thielmann M, et al. Intraoperative coronary graft flow determination--does it have a prognostic value for midterm graft patency. Eur J Med Res, 2006, 31(7): 267-272.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early outcome of coronary artery bypass graft surgery using bilateral internal mammary artery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content