title: Bilateral internal mammary artery grafting in obese: outcomes, concerns and controversies.
abstract: Obese patients are generally considered unsuitable to receive bilateral internal mammary arteries (BIMA) during coronary artery bypass grafting (CABG) due to the perceived vulnerability to sternal wound infection and lack of evidence supporting long-term survival benefit. However, no consistent evidence currently discourages the use of BIMA in obese patients. The present review questions the common perception that obesity unacceptably increases the risk of sternal wound complications in patients receiving BIMA grafting. Moreover, the use of skeletonization harvesting technique is expected to further minimize such a risk. Our institutional experience confirmed that BIMA grafting is a safe strategy which does not increase operative mortality and does not significantly affect the incidence of sternal wound complications. On the other hand, a long term benefit in terms of overall survival and freedom from repeat revascularization from the use of BIMA was found.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK.
authors.forename: Piergiusto
authors.initials: P
authors.lastname: Vitulli
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK. Electronic address: umberto.benedetto@hotmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
mesh_terms: D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D009765:Obesity / Q000150:complications*; D063868:Patient Outcome Assessment; D056346:Sternotomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology
keywords: Bilateral internal mammary artery grafting; Coronary artery bypass graft; Coronary heart disease; Obesity