Routine use of bilateral skeletonized internal mammary arteries for myocardial revascularization

Citation
J. Gurevitch et al., Routine use of bilateral skeletonized internal mammary arteries for myocardial revascularization, ANN THORAC, 68(2), 1999, pp. 406-411
Citations number
25
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Journal title
ANNALS OF THORACIC SURGERY
ISSN journal
0003-4975 → ACNP
Volume
68
Issue
2
Year of publication
1999
Pages
406 - 411
Database
ISI
SICI code
0003-4975(199908)68:2<406:RUOBSI>2.0.ZU;2-Y
Abstract
Background. Complete arterial myocardial revascularization without the use of saphenous veins grafts was primarily performed on selected patient popul ations such as the young and nondiabetic. In a recently developed surgical technique, the internal mammary artery is dissected gently as a longer skel etonized artery, providing greater versatility for complete arterial revasc ularization, without saphenous veins grafts. Methods. We prospectively evaluated the impact of the routine use of double skeletonized internal mammary artery in 472 patients who underwent coronar y artery bypass grafting between April 1996 and Tune 1997. Their average ag e was 65 years (30 to 87 years), 383 (83%) were men, and 89 (17%) women. On e hundred sixty-nine (36%) of the patients were older than 70 years, and 14 5 (31%) were diabetic. The average number of grafts was 3.2 per patient (tw o to six grafts). Results. Operative mortality was 1.7% (n = 8). The mortality of urgent and elective patients was 0.7% (3 of 410 patients), and that of emergency opera tions was 8.1% (5 of 62 patients; p < 0.01). There were three (0.6%) periop erative infarcts, and 6 patients (1.3%) sustained strokes. Sternal wound in fection occurred in 8 patients (1.7%). Postoperative follow-up (1 to 25 mon ths) was available in 462 patients (99%). Two-year actuarial survival was 9 6.8%, and 92% of the surviving patients are well and free of angina. Neithe r diabetes mellitus nor old age (>70 years) were significant independent pr edictors of any early or late untoward events. None of the 70 diabetic pati ents more than 65 years of age developed sternal wound infection. Chronic l ung disease was found to be the only independent predictor for sternal infe ctions. Conclusions. Routine use of bilateral skeletonized internal mammary artery is a safe replacement for the current myocardial revascularization techniqu e even in the old and diabetic patients. (C) 1999 by The Society of Thoraci c Surgeons.