title: The Use of Bilateral Internal Mammary Arteries for Coronary Revascularization in Patients with COPD: Is It a Good Idea?
abstract: BACKGROUND
  The use of bilateral internal mammary arteries (BIMA) is limited worldwide, especially in patients with chronic obstructive pulmonary disease (COPD). Thus, we assessed the safety of the use of BIMA in COPD patients.
  
  
  METHODS
  From cohorts of 8846 patients operated on at our center for primary isolated multi-vessel coronary bypass operations between 2002 and 2012, we studied two propensity-matched groups of patients with COPD who received either single internal mammary artery and saphenous vein grafts (SIMA group: 137 patients) or exclusively BIMA (BIMA group: 137 patients). Preoperative data were similar regarding age (63.59 ± 10.62 versus 65.55 ± 9.61 years; P = .10), body mass index (BMI) (28.6 ± 4.71 versus 28.42 ± 3.86 kg/m2; P = .72), diabetes mellitus (32% versus 27%; P = .08), EuroSCORE (4.34 ± 2.23 versus 4.8 ± 2.52; P = .09) and ejection fraction (58.7 ± 13.08% versus 60.29 ± 14.13%; P = .32).
  
  
  RESULTS
  No significant differences were noticed between the two groups regarding the number of peripheral anastomoses (3.07 ± 0.77 versus 3.06 ± 0.85; P = .90), total operation time (192.17 ± 43.06 versus 200.63 ± 39.24 min; P = .08), postoperative stroke (0.7% versus 0%; P = .29), myocardial infarction (2.92% versus 3.6%; P = .81), reintubation (2.9% versus 4.4%; P = .66), reexploration (0.7% versus 2.2%; P = .32), deep sternal wound infection (2.9% versus 3.6%; P = .81) and 30-day mortality (2.2% versus 2.9%; P = .77). However, postoperative blood loss (726.1 ± 468.35  versus 907 ± 890.58 mL; P = .03) was higher in the BIMA group.
  
  
  CONCLUSIONS
  COPD patients can benefit from coronary artery revascularization with BIMA; however, postoperative blood loss can be higher using this technique.
authors: Cardiac Surgery Department, MediClin Heart Institute Lahr/Baden, Lahr, Germany.|Cardiothoracic Surgery Department, Alexandria University, Alexandria, Egypt.
authors: Yasser Yehia
authors: YY
authors: Hegazy
authors: Cardiac Surgery Department, MediClin Heart Institute Lahr/Baden, Lahr, Germany.
authors: Ralf
authors: R
authors: Sodian
authors: Cardiothoracic Surgery Department, Alexandria University, Alexandria, Egypt.
authors: Wael
authors: W
authors: Hassanein
authors: Cardiac Surgery Department, MediClin Heart Institute Lahr/Baden, Lahr, Germany.|Cardiothoracic Surgery Department, Alexandria University, Alexandria, Egypt.
authors: Amr
authors: A
authors: Rayan
authors: Cardiac Surgery Department, MediClin Heart Institute Lahr/Baden, Lahr, Germany.|School of Medicine, Witten/Herdecke University, Witten, Germany.
authors: Juergen
authors: J
authors: Ennker
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012501:Saphenous Vein / Q000637:transplantation*