title: Bilateral internal mammary artery grafting: in situ versus Y-graft. Similar 20-year outcome.
abstract: OBJECTIVE
  The aim of this study was to evaluate the 20-year clinical outcome of patients undergoing coronary artery bypass grafting with bilateral internal mammary arteries (BIMAs) using two different configurations, in situ versus Y-graft.
  
  
  METHODS
  From September 1991 to December 2002, 2150 patients with multivessel coronary artery disease underwent isolated myocardial revascularization with BIMA grafting. BIMA was used as an in situ or Y-configuration in 1332 and 818 cases, respectively. A propensity score model was applied to calculate a standardized difference of ≤10% between groups (BIMA in situ vs BIMA Y-graft), and a cohort of 1468 matched patients was identified (734 in each group). Death, non-fatal myocardial infarction and the need for repeat revascularization were defined as 'major adverse cardiac events'.
  
  
  RESULTS
  Late mortality was 24.3% (n = 357) [BIMA in situ vs BIMA Y-graft: 26.9% (n = 197) vs 21.8% (n = 160)]; in 11.6% (n = 170) of cases death was due to cardiac causes [11.9% (n = 87) vs 11.3% (n = 83)]. The rate of major adverse cardiac events was 37.1% (n = 545) [40.8% (n = 299) vs 33.5% (n = 246)]. The 20-year survival was 59 ± 6% and the event-free survival was 45 ± 7%.
  
  
  CONCLUSIONS
  The clinical outcome of BIMA grafting is independent of surgical configuration. Y-grafting increases the flexibility of BIMA grafting and should be taken into account when a surgical strategy for myocardial revascularization needs to be planned.
authors.affiliation: L'Aquila University, L'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Prince Sultan Cardiac Center, Riyad, Saudi Arabia.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Iacò
authors.affiliation: Ain Shams Universities, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Allam
authors.affiliation: Benha Universities, Banha, Egypt.
authors.forename: Mohammed O
authors.initials: MO
authors.lastname: Awadi
authors.affiliation: Cairo Universities, Giza, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Osman
authors.affiliation: L'Aquila University, L'Aquila, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Clemente
authors.affiliation: Prince Sultan Cardiac Center, Riyad, Saudi Arabia am.calafiore@gmail.com.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Bilateral internal mammary artery; Myocardial revascularization; Y-grafting