Application of skeletonized bilateral internal mammary artery to coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HOU Jianfeng , ZHONG Zhaoji , LI Haojie , CHEN Kai , FAN Hongguang , CHANG Yi ,  GAO Ge , ZHENG Zhe ,  WANG Xiaoqi

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

GAO Ge, Email: 13661211082@139.com; WANG Xiaoqi, Email: wxqfwn@163.com

Keywords：

Coronary artery bypass grafting; bilateral internal mammary artery; skeletonized; surgery

DOI：

10.7507/1007-4848.202002127

Video：

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Objective To evaluate short-term clinical outcomes of skeletonized bilateral internal mammary artery (sBIMA) in coronary artery bypass grafting (CABG).Methods The clinical data of 62 patients (54 males and 8 females with an average age of 56.8±6.0 years) undergoing isolated CABG using sBIMA in our hospital from October 2016 to May 2017 were retrospectively analyzed. The coronary graft flow, perioperative clinical outcomes and CT results were reviewed.Results All the operations were carried out under extracorporeal circulation. Anastomosis of 124 internal mammary arteries was performed and 116 great saphenous veins were used simultaneously with an average anastomosis site of 4.5±0.8 for each patient. The cardiopulmonary bypass time was 116.4±22.9 min, aortic clamping time was 83.0±18.3 min, mechanical ventilation time was 20.8±21.3 h and ICU stay was 2.7±1.7 d. The graft flow of left internal mammary artery (LIMA), right internal mammary artery (RIMA) and great saphenous vein were 28.8±12.4 mL/min, 32.8±13.8 mL/min and 41.5±21.5 mL/min, respectively. There was no significant difference in the graft flow between LIMA and RIMA (P=0.112). There was no perioperative mortality, myocardial infarction or cerebrovascular accident. Only one male patient suffered sternal complication and poor wound healing and then received debridement as well as suturing. Coronary CT angiography showed that distal anastomosis of 7 vein grafts and 5 artery grafts was demonstrated shallow and 1 vein graft was undemonstrated, suggesting occlusion.Conclusion CABG with sBIMA is a safe and reliable technique with excellent early results.

Citation： HOU Jianfeng, ZHONG Zhaoji, LI Haojie, CHEN Kai, FAN Hongguang, CHANG Yi, GAO Ge, ZHENG Zhe, WANG Xiaoqi. Application of skeletonized bilateral internal mammary artery to coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1059-1062. doi: 10.7507/1007-4848.202002127 Copy

1.	Eagle KA, Guyton RA, Davidoff R, <italic>et al</italic>. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the ACC/AHA Task Force on Practice Guidelines. J Am Coll Cardiol, 2004, 44(5): e213-e310.
2.	Head SJ, Milojevic M, Daemen J, <italic>et al</italic>. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet, 2018, 391(10124): 939-948.
3.	Loop FD, Lytle BW, Cosgrove DM, <italic>et al</italic>. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med, 1986, 314: 1-6.
4.	Dion R, Verhelst R, Rousseau M, <italic>et al</italic>. Sequential mammary grafting. Clinical, functional, and angiographic assessment 6 months postoperatively in 231 consecutive patients. J Thorac Cardiovasc Surg, 1989, 98(1): 80-88.
5.	Tector AJ, Kress DC, Schmahl TM, <italic>et al</italic>. T-graft: a new method of coronary arterial revascularization. J Cardiovasc Surg (Torino), 1994, 35(6 Suppl 1): 19-23.
6.	Tatoulis J, Buxton BF, Fuller JA. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg, 1998, 66(3): 714-719.
7.	ElBardissi AW, Aranki SF, Sheng S, <italic>et al</italic>. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg, 2012, 143(2): 273-281.
8.	Yi G, Shine B, Rehman SM, et al. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation, 2014, 130(7): 539-545.
9.	Buttar SN, Yan TD, Taggart DP, <italic>et al</italic>. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis. Heart, 2017, 103: 1419-1426.
10.	Shroyer AL, Hattler B, Wagner TH, <italic>et al</italic>. Five-year outcomes after on-pump and off-pump coronary-artery bypass. N Engl J Med, 2017, 377(7): 623-632.
11.	Hu S, Zheng Z, Yuan X, <italic>et al</italic>. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation, 2010, 121(16): 1800-1808.
12.	李儒正, 天野篤, 廣瀬仁, 等. 超声刀在骨骼化动脉血管桥采取中的应用. 中国心血管病研究杂志, 2006, 4(6): 429-431.
13.	Umakanthan J, Jeyakumar P, Umakanthan B, <italic>et al</italic>. Barriers to the universal adoption of bilateral internal mammary artery grafting. Int J Surg, 2015, 16(Pt B): 179-182.
14.	Sá Michel O, Cavalcanti F, de Andrade J, <italic>et al</italic>. Skeletonized versus pedicled bilateral internal mammary artery grafting: outcomes and concerns analyzed through a meta-analytical approach. Int J Surg, 2015, 16(Pt B): 146-152.
15.	Ji Q, Zhao Y, Liu H, <italic>et al</italic>. Impacts of skeletonized bilateral internal mammary artery bypass grafting on the risk of deep sternal wound infection. Int Heart J, 2020, 61(2): 201-208.
16.	Schmidt SE, Jones JW, Thornby JI, <italic>et al</italic>. Improved survival with multiple left-sided bilateral internal thoracic artery grafts. Ann Thorac Surg, 1997, 64(1): 9-14.

1. Eagle KA, Guyton RA, Davidoff R, <italic>et al</italic>. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the ACC/AHA Task Force on Practice Guidelines. J Am Coll Cardiol, 2004, 44(5): e213-e310.
2. Head SJ, Milojevic M, Daemen J, <italic>et al</italic>. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet, 2018, 391(10124): 939-948.
3. Loop FD, Lytle BW, Cosgrove DM, <italic>et al</italic>. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med, 1986, 314: 1-6.
4. Dion R, Verhelst R, Rousseau M, <italic>et al</italic>. Sequential mammary grafting. Clinical, functional, and angiographic assessment 6 months postoperatively in 231 consecutive patients. J Thorac Cardiovasc Surg, 1989, 98(1): 80-88.
5. Tector AJ, Kress DC, Schmahl TM, <italic>et al</italic>. T-graft: a new method of coronary arterial revascularization. J Cardiovasc Surg (Torino), 1994, 35(6 Suppl 1): 19-23.
6. Tatoulis J, Buxton BF, Fuller JA. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg, 1998, 66(3): 714-719.
7. ElBardissi AW, Aranki SF, Sheng S, <italic>et al</italic>. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg, 2012, 143(2): 273-281.
8. Yi G, Shine B, Rehman SM, et al. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation, 2014, 130(7): 539-545.
9. Buttar SN, Yan TD, Taggart DP, <italic>et al</italic>. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis. Heart, 2017, 103: 1419-1426.
10. Shroyer AL, Hattler B, Wagner TH, <italic>et al</italic>. Five-year outcomes after on-pump and off-pump coronary-artery bypass. N Engl J Med, 2017, 377(7): 623-632.
11. Hu S, Zheng Z, Yuan X, <italic>et al</italic>. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation, 2010, 121(16): 1800-1808.
12. 李儒正, 天野篤, 廣瀬仁, 等. 超声刀在骨骼化动脉血管桥采取中的应用. 中国心血管病研究杂志, 2006, 4(6): 429-431.
13. Umakanthan J, Jeyakumar P, Umakanthan B, <italic>et al</italic>. Barriers to the universal adoption of bilateral internal mammary artery grafting. Int J Surg, 2015, 16(Pt B): 179-182.
14. Sá Michel O, Cavalcanti F, de Andrade J, <italic>et al</italic>. Skeletonized versus pedicled bilateral internal mammary artery grafting: outcomes and concerns analyzed through a meta-analytical approach. Int J Surg, 2015, 16(Pt B): 146-152.
15. Ji Q, Zhao Y, Liu H, <italic>et al</italic>. Impacts of skeletonized bilateral internal mammary artery bypass grafting on the risk of deep sternal wound infection. Int Heart J, 2020, 61(2): 201-208.
16. Schmidt SE, Jones JW, Thornby JI, <italic>et al</italic>. Improved survival with multiple left-sided bilateral internal thoracic artery grafts. Ann Thorac Surg, 1997, 64(1): 9-14.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of skeletonized bilateral internal mammary artery to coronary artery bypass grafting

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