Impact of Bilateral Internal Mammary Artery Grafting on the Immediate Outcome: A Double-Edged Sword in a Low Volume Heart Centre
Objective: To compare the perioperative mortality and immediate outcomes of CABG between using only SIMA graft and the use of BIMA graft by a single surgeon from low volume heart center in Thailand.
Methods: This retrospective case–control observational study, including two groups - (SIMA and BIMA) was conducted on all patients who underwent isolated first-time coronary bypass surgery at the Naresuan University Hospital from January 2010 to January 2016. The primary outcome was to compare the perioperative mortality and immediate outcomes of both groups. The secondary end point evaluated the risk factors that impacted deep sternal wound infections in BIMA grafting patients.
Results: Elective multiple CABG for multi-vessel diseases were performed on 94 patients. The early results of 70 patients who received SIMA grafts and 24 patients who received BIMA grafts were compared. No significant differences were observed between the SIMA and BIMA groups in the incidences of a deep sternal wound infection, the length of hospital stay and perioperative mortality. Risk of deep sternal wound infection was higher in BIMA group but was not significantly different between both groups. The results of the logistic regression analysis did not find the independent predictors of deep sternal wound infections.
Conclusions: In conclusion, there is no difference in terms of perioperative mortality and the immediate outcomes between the SIMA and the BIMA groups. As such, BIMA grafting can be safely performed in a low-volume heart center but should be selected patients for BIMA grafting.