Bimammary coronary artery bypass grafting in women: a retrospective study

• Schneider Yu.A.
• Tsoi V.G.
• Fomenko M.S.
• Pavlov A.A.
• Shilenko P.A.
• Dimitrova I.I.

Abstract

Background. The gold standard for revascularization of the anterior descending artery is the use of the left internal mammary artery. The majority of retrospective studies documented better long-term results of using 2 internal mammary arteries for myocardial revascularization as compared with only 1 internal mammary artery. Despite these findings, the number of works devoted to using 2 internal mammary arteries in women for aortocoronary bypass grafting (CABG) is scarce.

Objective: The study was aimed at evaluating the results of using 2 internal mammary arteries for surgical treatment of coronary artery disease in women.

Patients and methods: Between October 2012 and April 2022, we retrospectively analyzed the outcomes in 4905 patients who underwent CABG. Of these, the study enrolled a total of 1085 (39.5%) cases.

The inclusion criterion was the use of 2 internal mammary arteries for CABG. The primary endpoint was mortality, with secondary endpoints being myocardial infarction, stroke and wound infections. The mean age was 64.9±14.2 years (from 46 to 80 years), with an average EuroSCORE II of 2.3±1.4.

Results. Overall mortality amounted to 0.5% (5 patients). Operations were performed on-pump with cardioplegia in 55.1% of cases, off-pump in 36.4% of cases, and parallel on-pump in 8.5%. The frequency of procedure-related complications was as follows: postoperative bleeding – 2% (22 patients), wound infection – 1% (11 patients) and stroke – 0.1% (1 patient). The mean intensive care unit length of stay was 1.2±0.7 days. The average hospital stay was 9.8±1.2 days. The median duration of follow-up period amounted to 68.4 months (95% CI 65.1–66.7). The Kaplan–Meier method showed a 36-month survival rate of 94.8% (95% CI 93.1–97.4) and 60-month survival of 85.3% (95% CI 83.2–88.5).

Conclusion. Using 2 internal mammary arteries in women for myocardial revascularization is an effective and safe procedure, demonstrating satisfactory results of surgical treatment of coronary artery disease.

Keywords:internal mammary artery; ischemic heart disease; coronary artery bypass grafting; myocardial revascularization; heart failure

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