Bilateral internal mammary artery grafting: rationale and evidence.
Coronary artery bypass graft (CABG) surgery remains the preferred mode of revascularization in patients with complex multi-vessel coronary artery disease. The left internal mammary artery (IMA) and saphenous vein are the most commonly utilized conduits in CABG surgery and are still considered to be the gold standard by most surgeons. However, there is emerging evidence that use of bilateral IMAs is associated with significantly better long-term outcomes and the benefit increases with time from surgery. In spite of this incremental beneficiary effect, most surgeons are reluctant to use both IMAs, because it is technically more demanding, time-consuming and is associated with marginally higher sternal wound infection rates. This review highlights the histological features, physiological characteristics and genomics of IMAs that provide the basis for the use of these vessels during CABG surgery. Additionally, the superiority of the bilateral IMAs with regard to patency and long-term outcomes is also discussed in detail. Furthermore, the safety of using bilateral IMAs with regard to early postoperative outcomes with special reference to deep sternal wound infections has been addressed. The present review provides enough evidence to convince more surgeons about the advantages of bilateral IMA grafting.
['Davierwala|Piroze M|PM|', 'Mohr|Friedrich W|FW|']
D003324:Coronary Artery Disease D020869:Gene Expression Profiling D015894:Genome, Human D006801:Humans D007387:Internal Mammary-Coronary Artery Anastomosis D008323:Mammary Arteries D013530:Surgical Wound Infection D014654:Vascular Patency
Rationale Coronary artery bypass grafting Bilateral internal mammary grafting