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The Annals of Thoracic Surgery, Vol 49, 210-217, Copyright © 1990 by The Society of Thoracic Surgeons
NT Kouchoukos, TH Wareing, SF Murphy, C Pelate and WG Marshall Jr
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 less than 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
less than 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, diabetes, bilateral IMA
grafting, and need for prolonged (greater than 48 hours) mechanical
ventilation were associated with a significantly higher incidence of
sternal infection (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Risks of bilateral internal mammary artery bypass grafting
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
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