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Ann Thorac Surg 1999;67:1637-1642
© 1999 The Society of Thoracic Surgeons

Original Articles

Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits

Antonio M. Calafiore, MDa, Giuseppe Vitolla, MDa, Angela L. Iaco, MDa, Carlo Fino, MDa, Gabriele Di Giammarco, MDa, Francesco Marchesani, MDa, Giovanni Teodori, MDa, Giancarlo D’Addario, MDa, Valerio Mazzei, MDa

a Department of Cardiac Surgery, "G. D’Annunzio" University, Chieti, Italy

Accepted for publication December 11, 1998.

Address reprint requests to Dr Calafiore, Department of Cardiac Surgery, "G. D’Annunzio" University, S. Camillo de’ Lellis Hospital, Via C. Forlanini, 50, 66100 Chieti, Italy
e-mail: calafiore{at}unich.it

Background. To increase the number of anastomoses per patient, bilateral internal mammary arteries (BIMAs) were harvested with a skeletonized approach instead of a pedicled one.

Methods. One thousand one hundred forty-six patients underwent isolated myocardial revascularization using BIMAs, 304 receiving pedicled grafts (group A, October 1991 through May 1994) and 842 receiving skeletonized conduits (group B, June 1994 through June 1998). Group B had a higher incidence of patients with diabetes (223 versus 40, p < 0.001).

Results. The number of BIMA anastomoses per patient was significantly higher in group B (2.4 ± 0.3 versus 2.1 ± 0.4, p < 0.001), as well as the number of sequential grafts (288 versus 42, p < 0.001). Twenty-three patients (2.0%) died in the first 30 days after surgery, 5 in group A (1.6%) and 18 in group B (2.1%) (not significant). Postoperative complications were similar in both groups; the incidence of sternal wound healing problems was higher as a whole and with regard to diabetic patients (4 of 40 [10%] versus 5 of 223 [2.2%], p < 0.05) in group A. Seventy-one patients in group A and 133 (15.8%) in group B underwent a postoperative angiography. Patency rate was similar, both early (100% in group A versus 98.6% in group B, not significant) and late (98.6% in group A versus 98.4% in group B, not significant).

Conclusions. The use of skeletonized BIMA conduits allowed us to increase the number of BIMA anastomoses per patient with a lower rate of sternal wound complications and angiographic results similar to those obtained with pedicled BIMA conduits.




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