Does bilateral internal mammary artery grafting increase surgical risk?
The risk of bilateral internal mammary artery grafting was studied in three groups of patients who were computer matched for recognized risk factors: year of operation, age, gender, extent of coronary artery disease, left ventricular function, completeness of myocardial revascularization, and history of congestive heart failure. The patient groups differed in the fact that they received veins only, one internal mammary artery graft, or two internal mammary artery grafts. The operative mortality rates for these three groups were 1.8%, 0.3%, and 0.9%, respectively (no significant difference). Analysis of perioperative morbidity demonstrated no significant differences except for a slight increase in transfusion requirements in the group receiving two internal mammary artery grafts (p = 0.04). None of the patients with only vein grafts had wound complications. One patient in the group with one internal mammary artery graft had a wound complication (0.03%). Eight patients receiving two internal mammary artery grafts had wound complications (2.4%) (p = 0.002). The prevalence of wound complications in patients with diabetes mellitus was 5.7% and in those without diabetes mellitus, 0.3% (p = 0.01). The prevalence of wound complications in patients less than 60 years of age was 0.2%, in patients in their 60s, 1.6%, and in patients older than 70, 3.1% (p = 0.01). Multivariate logistic regression analysis identified diabetes mellitus and age and not bilateral internal mammary artery grafting as risk factors for wound complications. We conclude that bilateral internal mammary artery grafting does not increase surgical mortality and increases surgical morbidity by a slight increase in the mean transfusion requirement.
Cosgrove
D M
DM
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44106.
Lytle
B W
BW
Loop
F D
FD
Taylor
P C
PC
Stewart
R W
RW
Gill
C C
CC
Golding
L A
LA
Goormastic
M
M
D001803:Blood Transfusion; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D014654:Vascular Patency; D014945:Wound Healing