Abstract
PurposeThe left internal mammary artery in coronary artery bypass grafting (CABG) is considered to be an important intraoperative quality indicator with excellent long-term results. The purpose of this study is to compare the early outcomes of CABG with and without the left internal mammary artery (LIMA) in the South Asian population and to look for the utilization of LIMA as per the recommendations of the Society of Thoracic Surgeons in a developing country.Materials and methodsA retrospective review was carried out for all patients who underwent CABG from 2010 to 2015. Patients were divided into two groups on the basis of whether LIMA was used (Group I) or not used (Group II) as a conduit. Both groups were further subdivided into elective and urgent. Preoperative, intraoperative, and postoperative variables were recorded and compared.ResultsAfter exclusion, a total of 2619 patients underwent isolated CABG surgery during the required duration. The LIMA was used in 94% of the patients (n=2472) while 147 patients underwent CABG without LIMA. The use of LIMA was associated with significantly lower mortality (2% LIMA vs 8.8% no LIMA), as well as a decrease in major comorbidity, stroke, and prolonged ventilation. In the subgroup analysis, LIMA usage in elective and urgent cases was associated with significantly lower mortality (elective 1.6% LIMA vs 7.4% No LIMA) (urgent 4.8% LIMA vs 15.7 % no LIMA)) and major morbidity.ConclusionThe outcomes of CABG procedures without LIMA were not encouraging. Our results support compliance with standard adult cardiac surgery quality-of-care guidelines.
Highlights
Coronary artery bypass grafting (CABG) with arterial and vein graft conduits is the most commonly performed cardiac surgical procedure for coronary artery disease worldwide
The left internal mammary artery (LIMA) was used in 94% of the patients (n=2472) while 147 patients underwent CABG without LIMA
The use of LIMA was associated with significantly lower mortality (2% LIMA vs 8.8% no LIMA), as well as a decrease in major comorbidity, stroke, and prolonged ventilation
Summary
Coronary artery bypass grafting (CABG) with arterial and vein graft conduits is the most commonly performed cardiac surgical procedure for coronary artery disease worldwide. The most important and commonly used arterial graft is the left internal mammary artery (LIMA) due to its increased patency rate and resistance to atherosclerosis [1]. The long-term benefits of using LIMA to LAD are well-established and superior to vein grafts, the short-term outcomes may not have a significant impact [5]. The majority of the studies comparing the left internal mammary artery with the saphenous vein graft comes from the western population. This study is performed to evaluate the short-term outcome in terms of morbidity and mortality as defined by STS in adult patients undergoing CABG with and without using the internal mammary artery at a
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