title: Bilateral internal mammary artery for multi-territory myocardial revascularization: long-term follow-up of pedicled versus skeletonized conduits.
abstract: OBJECTIVE
  The aim of this study was to evaluate 17-year actual clinical outcomes of patients undergoing coronary artery bypass graft (CABG) using skeletonized versus pedicled bilateral internal mammary arteries (BIMAs).
  
  
  METHODS
  From September 1991 to June 1996, 548 consecutive patients underwent CABG for multivessel disease using BIMA. After propensity matching, 350 patients were enrolled: 175 patients with skeletonized BIMA (Group S) and 175 with pedicled BIMA (Group P). The two groups were adequately comparable. Composite end-point: deaths, new revascularization and new myocardial infarctions were defined as 'events'.
  
  
  RESULTS
  Group S provided a higher rate of total arterial myocardial revascularization (94.3 vs 82.9%, P 0.001) with a higher average number of arterial anastomoses (3.1 ± 0.8 vs 2.7 ± 0.8, P < 0.001) and BIMA anastomoses (2.5 ± 0.3 vs 2.1 ± 0.3, P < 0.001). In Group S, the incidence of sequential grafts was higher (37.7 vs 17.7%, P < 0.001). The rate of sternal wound healing problems was lower (1.7 vs 7.4%, P = 0.010). Thirty-day mortality and morbidity were similar. The median survival time of survivors was 17.8 years (min-max = 17.0-21.5); 17.3 (17.0-18.0) in Group S vs 19.1 (18.1-21.5) in Group P, P < 0.001. Seventeen-year actual outcomes were better in Group S: deaths (8.7 vs 27.9%, P < 0.001), cardiac deaths (4.7 vs 13.4%, P = 0.005), cardiac events (10.5 vs 22.1%, P = 0.003), new revascularization (2.9 vs 8.7%, P = 0.021) and events (15.1 vs 36.1%, P < 0.001).
  
  
  CONCLUSIONS
  Skeletonization of BIMA allows one to achieve a higher rate of arterial grafting and better outcome if compared with pedicled BIMA.
authors: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Michele
authors: M
authors: Di Mauro
authors: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
authors: Angela L
authors: AL
authors: Iacò
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Angelo
authors: A
authors: Acitelli
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Gabriele
authors: G
authors: D'Ambrosio
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Laura
authors: L
authors: Filipponi
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Elisa
authors: E
authors: Salustri
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Chiara
authors: C
authors: De Luca
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Silvio
authors: S
authors: Romano
authors: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors: Maria
authors: M
authors: Penco
authors: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia am.calafiore@gmail.com.
authors: Antonio M
authors: AM
authors: Calafiore
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bilateral mammary artery; Pedicled mammary artery; Skeletonization