Mid-Term Results of Revascularization of the Left Coronary Artery Territory Using in Situ Skeletonized Bilateral Internal Mammary Arteries

Abstract
Background: In Situ Skeletonized Bilateral Internal Mam-mary Arteries (BIMA) grafting to the left coronary artery can be used in almost all surgical revascularization patients. We sought to evaluate our early and mid-term patency rate of both arteries to different targets of the left coronary artery territory.
Aim of Study: Assess the early and mid-term outcome of using the In Situ BIMA to revascularize the left coronary artery territory and the difference in the outcome between Left Internal Mammary Artery (LIMA) and Right Internal Mammary Artery (RIMA )grafting to the Left Anterior De-scending coronary artery (LAD) as a main target for ischaemic patients scheduled for CABG. We evaluated this technique using the BIMA as skeletonized conduits for technical issues and on beating heart to standardize the methodology.
Patients and Methods: Retrospective data collection for two groups of consecutive patients from Jan. 2012 to Jan. 2016 with revascularization to two or more sites in the territory of left coronary artery and In situ BIMA were used. Arrange-ment of the bilateral IMAs is usually decided according to the coronary anatomy, quality and flow of the grafts. (GroupI) (100 patients), LIMA was used to supply the LAD and (Group II) (33 patients), RIMA was used to supply the LAD. Direct coronary angiography was done for post-operative symptomatic patients in both groups (8/100) (8%) and (3/33) (9%) (ns) respectively. Myocardial Perfusion Imaging (MPI) was done to the rest of both groups after written consents.
Results: There were no differences in the main pre oper-ative demographics. No significant intraoperative difference between the LIMA and RIMA concerning the diameter, wall thickness and the occurrence rates of atherosclerosis. The average total numbers of anastomoses and bilateral IMA anastomoses per patient were (3.2±0.9) and (2.6±0.6), respec-tively. Significant difference between both groups for the number of BIMA anastomoses (2.2±0.6 vs. 2.7±0.8) (p<0.05).
There were no hospital mortality and no significant difference regarding major cardiac events or sternal wound infection. The patencies to the LAD were (94/100) (94%) and (31/33) (93%) (p=0.324), and the patencies to other than the LAD were (96/100) (96%) and (31/33) (93%) (p=0.195), respectively after a mean follow-up period of (42±34 months).
Conclusions: In situ skeletonized bilateral IMA grafting for revascularization of the territory of the left coronary artery is feasible and can be used routinely in all patients with excellent results. Arrangement of bilateral IMAs did not affect the mid-term outcome.