Cirugía coronaria con doble arteria mamaria: nuestra experiencia inicial y resultados a corto plazo

Abstract

IntroductionBilateral internal mammary grafting (BIMA) in coronary bypass surgery (CABG) improves survival and recurrence of symptoms. There is still controversy regarding complications arising from its use and graft configuration strategy. We expose the short-term outcomes of BIMA grafting in our institution, as well as the different graft configurations available. MethodsPatients who underwent CABG with BIMA grafting between January 2011 and December 2015 were analyzed. Results413 (53.4%) out of 767 CABG patients underwent BIMA grafting. Mean age was 64 (SD: 8.7) years, with a 87.7% male. Mean EuroSCORE II was 2.7%. Three hundred and forty-nine patients (85.1%) underwent off-pump CABG. BIMA grafting with composite T-graft configuration was performed in 250 patients (60.5%), BIMA in situ grafting in 142 (34.3%) and BIMA grafting with free right internal mammary artery (RIMA) from the aorta, 21 patients (5.1%).30-day mortality (0.7%). Six patients (1.4%) needed BCIA for low cardiac output, five presented sternal wound infection (1.2%) or mediastinitis (1.2%), three stroke (0.7%), two patients (0.5%) had renal failure with hemodialysis and four (1%) needed re-operation for bleeding. ConclusionsBIMA grafting is a safe technique with excellent short term outcomes. Large prospective randomized trials with long term follow-up are still needed to clarify the optimal surgical strategy for graft configuration.