title: Bilateral internal mammary artery bypass grafting: long-term clinical benefits in a series of 1000 patients.
abstract: OBJECTIVE
  Bilateral internal mammary arteries (BIMA) remain widely underused in coronary artery bypass grafting (CABG). In this study, we aim to investigate the early and long-term outcomes of BIMA grafts in isolated CABGs.
  
  
  METHODS
  Single-centre retrospective observational study.
  
  
  METHODS
  University Hospital, Nancy.
  
  
  METHODS
  1000 consecutive patients undergoing elective, isolated, primary, multiple CABGs using BIMA grafts and supplemental venous grafts for multi-vessel coronary disease.
  
  
  METHODS
  In-hospital mortality and major morbidity, and long-term all-cause mortality.
  
  
  RESULTS
  Mean age of the overall population was 60 ± 15 years. A left ventricular ejection fraction (LVEF) ≤ 45% was found in 28% of the patients and 27.1% of the patients were diabetics. Comorbidities were represented by chronic renal failure, chronic obstructive pulmonary disease and peripheral artery disease in 11, 11.7 and 27.3% of the cases, respectively. The in-hospital mortality rate was 2.8%. Early postoperative morbidity included myocardial infarction (2.2%), stroke (0.9%), mesenteric ischaemia (0.7%) and mediastinitis (2.2%). The Kaplan-Meier 8-year survival rates for patients less than 65 and between 65 and 74 years of age were 88% and 66%, respectively (p < 0.01). Multiple regression analysis showed that patients' age 65 years or greater at baseline (OR 2.3; 95% CI 1.3 to 4, p < 0.001), acute coronary syndrome (OR 1.9; 95% CI 1.1 to 3.4, p = 0.02), chronic renal failure (OR 2.7; 95% CI 1.4 to 5.2, p < 0.001), peripheral artery disease (OR 3.1; 95% CI 1.8 to 5.5, p < 0.001) and LVEF ≤ 45% (OR 2.6; 95% CI 1.4 to 4.5, p < 0.001) were independent predictors of long-term cardiovascular mortality.
  
  
  CONCLUSIONS
  Our longitudinal analysis presents encouraging data concerning operative risk of BIMA grafting and provides excellent long-term survival in appropriately selected patients.
authors.affiliation: Département Cardiologie, CHU Nancy, rue de Morvan, Vandoeuvre les Nancy 54500, France. batricpopovic@orange.fr
authors.forename: Batric
authors.initials: B
authors.lastname: Popovic
authors.forename: Damien
authors.initials: D
authors.lastname: Voillot
authors.forename: Pablo
authors.initials: P
authors.lastname: Maureira
authors.forename: Fabrice
authors.initials: F
authors.lastname: Vanhuyse
authors.forename: Nelly
authors.initials: N
authors.lastname: Agrinier
authors.forename: Etienne
authors.initials: E
authors.lastname: Aliot
authors.forename: Thierry
authors.initials: T
authors.lastname: Folliguet
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Villemot
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Coronary Artery Disease