title: Bilateral internal mammary artery grafts, mortality and morbidity: an analysis of 1 526 360 coronary bypass operations.
abstract: OBJECTIVE
  The objective of this study was to investigate the impact of bilateral internal mammary artery (BIMA) on early outcomes after coronary artery bypass grafting.
  
  
  METHODS
  Retrospective database analysis.
  
  
  METHODS
  US hospitals.
  
  
  METHODS
  1 526 360 patients (mean age 65 years, 73% male) from the Nationwide Inpatient Sample from 2002-2008 who underwent isolated coronary artery bypass grafting with at least one internal mammary artery.
  
  
  METHODS
  Single versus BIMA bypass grafting.
  
  
  METHODS
  Inhospital mortality, deep sternal wound infection (DSWI).
  
  
  RESULTS
  The rate of BIMA use was 3.9%. Use of BIMA was independently associated with slightly lower inhospital mortality (unadjusted rate 1.1% vs 1.7%, adjusted OR 0.86, 95% CI 0.79 to 0.93). The DSWI rate was 1.4%. The independent predictors of DSWI were female gender (OR 1.06), congestive heart failure (OR 6.22), chronic pulmonary disease (OR 1.57), obesity (OR 1.17), diabetes mellitus (OR 1.04; OR 1.51 with chronic complication) and chronic renal failure (OR 2.13; OR 2.63 with dialysis). The use of BIMA was not an independent predictor of DSWI (OR 1.03, 95% CI 0.96 to 1.10). BIMA was associated with higher incidence of DSWI in patients with chronic complications of diabetes mellitus (OR 1.90, 95% CI 1.51 to 2.41).
  
  
  CONCLUSIONS
  BIMA grafting is associated with increased risk of DSWI only in patients with severe, chronic diabetes. The incremental morbidity and mortality of DSWI does not justify denial of BIMA in the majority of patients.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, 1190 Fifth Avenue, New York, NY 10029, USA.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.forename: Paul
authors.initials: P
authors.lastname: Cavallaro
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
mesh_terms: D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: CARDIAC SURGERY