OC81 TOTAL ARTERIAL CORONARY ARTERY REVASCULARIZATION USING BOTH INTERNAL MAMMARY ARTERIES WITH Y CONFIGURATION: LONG TERM RESULTS

Abstract

Abstract Background and aim: Bilateral internal mammary artery (BIMA) grafts are used for coronary revascularisation by only a minority of surgeons, despite a growing body of evidence suggesting improved survival when compared to use of only one internal mammary artery with additional saphenous vein grafts. Main disadvantages reported, consist in sternal wound infection, increased technical complexity. We report our experience discussing technical considerations and long term follow up. Methods: Between January 2010 and February 2017, 1038 patients with multivessel coronary artery disease underwent myocardial revascularization with bilateral internal mammary arteries (BIMA) adopting Y configuration (male = 877 [84.5%]; mean age 65.7 ± 8.7 years, range 36–87). More than 25 % were obese (body mass index > 30) N°261 and 32.5n% were affected by diabetes mellitus. Results: Both internal mammary arteries are harvested using a completely skeletonized technique. This minimizes chest wall trauma, achieves maximum length, and makes constructing the “Y” graft and performing subsequent sequential grafting easier. An off pump technique was preferred in 114 patients, for the remaining overall cardiopulmonary bypass was 68 ± 28.0 minutes and aortic cross clamping was 50 ± 20 minutes. (Skin to skin median 240 minutes). Thirty days mortality rate resulted 1.4% (15/1038). Other postoperative complications and follow up are collected and reported. Conclusions: data from literature reveals that use of bilateral mammary arteries is associated with improved long term survival, also in diabetic patients. The reported disadvantages as sternal dehiscence are actually not so relevant as well operations times are not so increased.