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Ann Thorac Surg 1990;49:210-219
© 1990 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri USA
* Address reprint requests to Dr Kouchoukos, Jewish Hospital at Washington University Medical Center, 216 S Kingshighway Blvd, St. Louis, MO 63110.
Although use of one internal mammary artery (IMA) for coronary artery bypass grafting does not appear to be associated with increased risk, the results with both IMAs are less certain; the potential for a higher incidence of sternal wound infection as a result of devascularization of the sternum is a major concern. During a 42-month interval ending July 1988, 1,566 patients had coronary artery bypass grafting alone or in combination with other procedures: 633 received only vein grafts, 687 had unilateral IMA grafting, and 246 had bilateral IMA grafting. The IMA patients were younger, were more often male, had better cardiac function, and underwent fewer emergent, urgent, or combined procedures than the patients receiving vein grafts (p < 0.05). Thirty-day mortality was lower among the IMA patients (unilateral IMA group, 2.8%; bilateral IMA group, 3.7%; and vein graft group, 7.9%; p = 0.001). With the exception of sternal wound problems, occurrence rates for postoperative complications among the IMA patients did not differ significantly from or were lower (p < 0.05) than those among the patients with vein grafts. Sternal infections occurred with greater frequency among the bilateral IMA patients (6.9%) than among the unilateral IMA (1.9%) or vein graft (1.3%) patients (p = 0.001). By univariate analysis, obesity, diabetee, bilateral IMA grafting, and need for prolonged (>48 hours) mechanical ventilation were associated with a significantly higher incidence of sternal infection (p < 0.05). Multivariate logistic regression analysis identified use of bilateral IMA grafts (p = 0.0001), obesity (p = 0.0014), and prolonged mechanical ventilation (p = 0.0018) as significant risk factors for the development of sternal infection. We conclude that bilateral IMA grafting is an important predictor of sternal infection. It should be used selectively in obese or diabetic patients and in patients who are likely to require prolonged mechanical ventilation postoperatively.
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T. Carrel, P. Horber, and M. I. Turina Operation for Two-Vessel Coronary Artery Disease: Midterm Results of Bilateral ITA Grafting Versus Unilateral ITA and Saphenous Vein Grafting Ann. Thorac. Surg., November 1, 1996; 62(5): 1289 - 1294. [Abstract] [Full Text]
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R. Nottin, J. M. Grinda, S. Anidjar, T. Folliguet, M. Detroux, and S. C. Planche CORONARY-CORONARY BYPASS GRAFT: AN ARTERIAL CONDUIT-SPARING PROCEDURE J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1223 - 1230. [Abstract] [Full Text]
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J. G. Grandjean, A. A. Voors, P. W. Boonstra, P. d. Heyer, and T. Ebels EXCLUSIVE USE OF ARTERIAL GRAFTS IN CORONARY ARTERY BYPASS OPERATIONS FOR THREE-VESSEL DISEASE: USE OF BOTH THORACIC ARTERIES AND THE GASTROEPIPLOIC ARTERY IN 256 CONSECUTIVE PATIENTS J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 935 - 942. [Abstract] [Full Text]
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V. Rao, G. T. Christakis, R. D. Weisel, R. Grewal, J. Ivanov, G. Cohen, S. M. Carson, and D. A. G. Mickle Does the Internal Thoracic Artery Graft Delay the Recovery of Myocardial Metabolism? Ann. Thorac. Surg., October 1, 1996; 62(4): 1039 - 1044. [Abstract] [Full Text]
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K. Ueyama, R. Sakata, Y. Umebayashi, Y. Nakayama, K. Arakaki, and M. Ura IN SITU RIGHT INTERNAL THORACIC ARTERY GRAFT VIA TRANSVERSE SINUS FOR REVASCULARIZATION OF POSTEROLATERAL WALL: EARLY RESULTS IN 116 CASES J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 731 - 736. [Abstract] [Full Text]
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F. D. A. d. Costa, I. A. d. Costa, R. Poffo, D. Abuchaim, R. Gaspar, L. Garcia, and D. L. Faraco Myocardial Revascularization With the Radial Artery: A Clinical and Angiographic Study Ann. Thorac. Surg., August 1, 1996; 62(2): 475 - 479. [Abstract] [Full Text]
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S. Voutilainen, K. Verkkala, A. Jarvinen, and P. Keto Angiographic 5-Year Follow-up Study of Right Gastroepiploic Artery Grafts Ann. Thorac. Surg., August 1, 1996; 62(2): 501 - 505. [Abstract] [Full Text]
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P. A. Kurlansky, M. J. Dorman, D. L. Galbut, N. L. Moreno, E. A. Traad, R. G. Carrillo, M. Zucker, L. Sanchez, and G. Ebra Bilateral Internal Mammary Artery Grafting in Women: A 21-Year Experience Ann. Thorac. Surg., July 1, 1996; 62(1): 63 - 69. [Abstract] [Full Text]
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T. P. M. Study Group RISK FACTORS FOR DEEP STERNAL WOUND INFECTION AFTER STERNOTOMY: A PROSPECTIVE, MULTICENTER STUDY J. Thorac. Cardiovasc. Surg., June 1, 1996; 111(6): 1200 - 1207. [Abstract] [Full Text]
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R. M. El Oakley and J. E. Wright Postoperative Mediastinitis: Classification and Management Ann. Thorac. Surg., March 1, 1996; 61(3): 1030 - 1036. [Abstract] [Full Text]
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L. R.S. Dewar, W.R. E. Jamieson, M. T. Janusz, M. Adeli-Sardo, E. Germann, J. S. MacNab, and G. F. O. Tyers Unilateral Versus Bilateral Internal Mammary Revascularization : Survival and Event-Free Performance Circulation, November 1, 1995; 92(9): 8 - 13. [Abstract] [Full Text]
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C. A. Dietl, C. H. Benoit, C. L. Gilbert, E. L. Woods, W. F. Pharr, M. D. Berkheimer, N. P. Madigan, and F. J. Menapace 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, November 1, 1995; 92(9): 92 - 97. [Abstract] [Full Text]
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G.-W. He, T. E. Acuff, W. H. Ryan, Y.-H. He, and M. J. Mack DETERMINANTS OF OPERATIVE MORTALITY IN REOPERATIVE CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 971 - 978. [Abstract] [Full Text]
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O. Jegaden, A. Eker, P. Montagna, J. Ossette, G. De Gevigney, G. Finet, A. S. Pierre, D. Revel, R. Itti, and P. H. Mikaeloff Risk and results of bypass grafting using bilateral internal mammary and right gastroepiploic arteries Ann. Thorac. Surg., April 1, 1995; 59(4): 955 - 960. [Abstract] [PDF]
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 E. Sivertssen, M. Abdelnoor, and N. B. Fjeld Prolonged Aortic Cross-Clamping Time and Cardiopulmonary Bypass Time Have a Gradient Effect on Early Mortality in Open-Heart Surgery Vascular and Endovascular Surgery, March 1, 1995; 29(2): 91 - 97. [Abstract] [PDF]
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R. A. de Jesus and R. D. Acland Anatomic study of the collateral blood supply of the sternum Ann. Thorac. Surg., January 1, 1995; 59(1): 163 - 168. [Abstract] [PDF]
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E. Berreklouw, J. P. A. M. Schonberger, J. H. Bavinck, V. J. Verwaal, E. L. Koldewijn, F. van Der Linden, I. Van der Tweel, and J. J. Bredee Similar hospital morbidity with the use of one or two internal thoracic arteries Ann. Thorac. Surg., June 1, 1994; 57(6): 1564 - 1572. [Abstract] [PDF]
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F. L. Grover, R. R. Johnson, G. Marshall, K. E. Hammermeister, and Department of Veterans Affairs Cardiac Surgeons Impact of mammary grafts on coronary bypass operative mortality and morbidity Ann. Thorac. Surg., March 1, 1994; 57(3): 559 - 569. [Abstract] [PDF]
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F. H. Edwards, R. E. Clark, and M. Schwartz Impact of internal mammary artery conduits on operative mortality in coronary revascularization Ann. Thorac. Surg., January 1, 1994; 57(1): 27 - 32. [Abstract] [PDF]
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G.-W. He, W. H. Ryan, T. E. Acuff, R. T. Bowman, M. B. Douthit, C.-Q. Yang, and M. J. Mack Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 196 - 202. [Abstract] [Full Text]
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G. M. Palatianos, H. Bolooki, M. D. Horowitz, M. H. Lowery, S. P. Rosenthal, S. K. C. Chandarlapaty, G. N. Sfakianakis, and G. A. Kaiser Sequential internal mammary artery grafts for coronary artery bypass Ann. Thorac. Surg., November 1, 1993; 56(5): 1136 - 1140. [Abstract] [PDF]
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K. D. Accola, E. L. Jones, J. M. Craver, W. S. Weintraub, and R. A. Guyton Bilateral mammary artery grafting: Avoidance of complications with extended use Ann. Thorac. Surg., October 1, 1993; 56(4): 872 - 879. [Abstract] [PDF]
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J. Ramstrom, O. Lund, E. Cadavid, S. Oxelbark, J. B. Thuren, and A. C. Henze Right internal mammary artery for myocardial revascularization: Early results and indications Ann. Thorac. Surg., June 1, 1993; 55(6): 1485 - 1491. [Abstract] [PDF]
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G. E. Green, D. G. Swistel, J. Castro, Z. Hillel, and J. Thornton Sternal blood flow during mobilization of the internal thoracic arteries Ann. Thorac. Surg., April 1, 1993; 55(4): 967 - 970. [Abstract] [PDF]
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J. E. Molina Primary closure for infected dehiscence of the sternum Ann. Thorac. Surg., February 1, 1993; 55(2): 459 - 463. [Abstract] [PDF]
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J. M. Cunningham, M. A. Gharavi, R. Fardin, and R. A. Meek Considerations in the skeletonization technique of internal thoracic artery dissection Ann. Thorac. Surg., November 1, 1992; 54(5): 947 - 950. [Abstract] [PDF]
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 T. J. Francel, C. R. Dufresne, W. A. Baumgartner, and J. O'Kelley Anatomic and Clinical Considerations of an Internal Mammary Artery Harvest Arch Surg, September 1, 1992; 127(9): 1107 - 1111. [Abstract] [PDF]
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