title: Bilateral skeletonized mammary artery grafting: experience with 560 consecutive patients.
abstract: OBJECTIVE
  To test the hypothesis that the skeletonized technique of harvesting the internal thoracic artery improves the surgical results of bilateral internal thoracic artery grafting, we reviewed our 7-year experience with this technique.
  
  
  METHODS
  Between July 1987 and December 1994, 560 patients received bilateral internal thoracic artery grafts and 236 additional grafts (average 2.6 +/- 0.6 anastomoses per patient). There were 515 men (92%) and the average age was 56.9 +/- 8.8 years. There were 63 diabetic patients (11.3%). During harvesting, the internal thoracic arteries were always totally skeletonized from the surrounding tissues without the use of electrocautery.
  
  
  RESULTS
  Postoperative complications included reoperation for bleeding, 17 patients (3%), phrenic nerve paresis, 17 patients (3%), acute respiratory distress syndrome, 9 patients (1.6%), digestive complications, 8 patients (1.4%), neurologic complications, 6 patients (1.1%), and sternal complications, 6 patients (1.1%). No wound complications were observed in diabetic patients. The hospital mortality rate was 1.6% (9 patients, 2 cardiac causes). The early patency of internal thoracic artery grafts was 97.9%. Follow-up averages 29 +/- 20 months. There were 14 late deaths (4 cardiac causes). Angina recurred in 51 patients and the maximal stress test was abnormal in 47 patients.
  
  
  CONCLUSIONS
  Bilateral internal thoracic artery grafting with skeletonized harvesting carried low post-operative mortality and morbidity and therefore it could be applied routinely without the fear of increased complication rate.
authors.affiliation: Department of Cardiac Surgery, Hôpital Saint Joseph, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Bical
authors.forename: E
authors.initials: E
authors.lastname: Braunberger
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: J
authors.initials: J
authors.lastname: Robinault
authors.forename: J C
authors.initials: JC
authors.lastname: Foiret
authors.forename: Y
authors.initials: Y
authors.lastname: Fromes
authors.forename: D
authors.initials: D
authors.lastname: Gaillard
authors.forename: P
authors.initials: P
authors.lastname: Maribas
authors.forename: T
authors.initials: T
authors.lastname: Bouharaoua
authors.forename: G
authors.initials: G
authors.lastname: Souffrant
authors.forename: A
authors.initials: A
authors.lastname: Vanetti
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014654:Vascular Patency