title: The Use of Bilateral Internal Mammary Artery Grafting in Different Degrees of Obesity.
abstract: BackgroundObesity is a limiting factor for the use of bilateral internal mammary arteries (BIMAs). Therefore, we assessed the safety of their use in different degrees of obesity.Patients and MethodsWe studied two groups of patients with obesity using propensity matching. The first group received single internal mammary artery and saphenous vein grafts (SIMA group, 526 patients) and the second group received bilateral internal mammary arteries (BIMA group, 526 patients). Patients were classified further according to their body mass index (BMI) into overweight (BMI = 25-29.9 kg/m2), obese (BMI = 30-34.9 kg/m2), and severely obese (BMI ≥ 35 kg/m2).ResultsPreoperative data were similar regarding age (62.78 ± 9.96 vs. 62.98 ± 9.66 years;p= 0.734), female sex (17.5 vs. 18.6%;p= 0.631), diabetes mellitus (26.3 vs. 27.2%;p= 0.74), EuroSCORE (3.21 ± 2.23 vs. 3.18 ± 2.41;p= 0.968), and COPD (16 vs. 16%;p= 1). No significant differences were noticed between the two groups regarding the number of peripheral anastomoses (3.09 ± 0.84 vs. 3.12 ± 0.83;p= 0.633), myocardial infarction (1.7 vs. 1.7%;p= 1), reexploration (1.3 vs. 2.1%;p= 0.34), deep sternal wound infection (DSWI) (2.1 vs. 2.9%;p= 0.43), and 30-day mortality (0.8 vs. 1.1%;p= 0.53). Multivariate analysis identified BMI and intensive care unit stay as independent predictors for DSWI. However, postoperative blood loss (694.56 ± 631.84 vs. 811.67 ± 688.73 mL;p< 0.001) and the incidence of pneumothorax (1 vs. 2.7%;p= 0.037) were higher in BIMA group.ConclusionPatients with obesity can benefit from BIMA grafting. However, postoperative blood loss and the incidence of pneumothorax can be higher using this technique.
authors.affiliation: Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany.|Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: Hegazy
authors.affiliation: Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Wael
authors.initials: W
authors.lastname: Hassanein
authors.affiliation: Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany.|School of Medicine, Faculty of Health, University of Witten Herdecke, Witten, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Ennker
authors.affiliation: Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany.
authors.forename: Noha
authors.initials: N
authors.lastname: Keshk
authors.affiliation: Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome