Skeletonized bilateral internal mammary arteries for non-elective surgical revascularization in unstable angina.
OBJECTIVE
The aim of this study was to evaluate the feasibility, safety and outcome of skeletonized bilateral internal mammary arteries (BIMA) in patients with unstable angina (UA) undergoing non-elective myocardial revascularization.


METHODS
Between January 1997 and December 2003, 758 patients, mean age 62+/-12 years, underwent non-elective coronary artery bypass grafting (CABG) for unstable angina. Two hundred and five (27%) were operated emergently and 503 (73%) urgently. BIMA were employed in 320 (42%) patients (Group B) and isolated left IMA and/or saphenous vein grafts in the remaining 438 (58%) patients (Group M).


RESULTS
In-hospital mortality (B = 5.9% and M = 5.3%), and perioperative myocardial infarction (B = 2.2%; M = 1.96%) were similar between the two groups (P = ns). Actuarial survival at 1, 3 and 7 years was 98.7, 97.5 and 96.2% in B and 99, 94.3 and 88.4% in M (P < 0.05 at 7 years follow-up). At 7 years follow-up, the event-free cardiac survival (92 vs. 87%, P = 0.021), angina-free survival (98.6 vs. 94%, P = 0.039), reoperation-free cardiac survival (98 vs. 95%, P = 0.04) and infarct-free cardiac survival (98.7 vs. 96%, P = 0.05) were better in Group B. Multivariate analysis identified age > 65 years (P = 0.02), LVEF < 35% (P = 0.01), > 1 ischemic irreversible area (P = 0.03) as independent predictors for late deaths, while the use of the LIMA (P=0.006) and both mammary arteries (P=0.001) decreased the risk of late deaths.


CONCLUSIONS
The use of BIMA in non-elective CABG for UA is safe and effective. Mid-term outcome, however, are superior with improved freedom from cardiac death, from coronary reintervention and from myocardial infarction.
Bonacchi
Massimo
M
Department of Cardiac Surgery, Cattedra e Scuola di Specializzazione in Cardiochirurgia, University of Florence, Viale Morgagni, 85, Careggi, 50134 Firenze, Italy. mbonacchi@unifi.it
Prifti
Edvin
E
Maiani
Massimo
M
Giunti
Gabriele
G
Leacche
Marzia
M
D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome