University of Oulu

Antonino S. Rubino, Giuseppe Gatti, Daniel Reichart, Tuomas Tauriainen, Marisa De Feo, Francesco Onorati, Aniello Pappalardo, Sidney Chocron, Helmut Gulbins, Magnus Dalén, Peter Svenarud, Giuseppe Faggian, Ilaria Franzese, Giuseppe Santarpino, Theodor Fischlein, Daniele Maselli, Saverio Nardella, Riccardo Gherli, Aamer Ahmed, Francesco Santini, Antonio Salsano, Francesco Nicolini, Marco Zanobini, Matteo Saccocci, Vito G. Ruggieri, Karl Bounader, Carmelo Mignosa, Paola D’Errigo, Stefano Rosato, Juhani Airaksinen, Andrea Perrotti, Fausto Biancari, Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly, The Annals of Thoracic Surgery, Volume 105, Issue 6, 2018, Pages 1717-1723, ISSN 0003-4975,

Early outcome of bilateral versus single internal mammary artery grafting in the elderly

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Author: Rubino, Antonino S.1; Gatti, Giuseppe2; Reichart, Daniel3;
Organizations: 1Centro Clinico-Diagnostico “G.B. Morgagni,” Centro Cuore, Pedara, Italy
2Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
3Hamburg University Heart Center, Hamburg, Germany
4Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
5Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
6Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
7Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
8Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
9Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
10Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
11Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
12Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
13Division of Cardiac Surgery, University of Genoa, Genoa, Italy
14Division of Cardiac Surgery, University of Parma, Parma, Italy
15Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy
16Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
17National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
18Heart Center, Turku University Hospital, Turku, Finland
19Department of Surgery, University of Turku, Turku, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-10-15


Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting.

Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis.

Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009).

Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

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Series: The annals of thoracic surgery
ISSN: 0003-4975
ISSN-E: 1552-6259
ISSN-L: 0003-4975
Volume: 105
Issue: 6
Pages: 1717 - 1723
DOI: 10.1016/j.athoracsur.2017.11.079
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2018 by The Society of Thoracic Surgeons Published by Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license