BILATERAL SKELETONIZED MAMMARY ARTERY GRAFTING - EXPERIENCE WITH 560 CONSECUTIVE PATIENTS

Objective. To test the hypothesis that the skeletonized technique of h arvesting the internal thoracic artery improves the surgical results o f bilateral internal thoracic artery grafting, we reviewed our 7-year experience with this technique. Methods. Between July 1987 and Decembe r 1994, 560 patients received bilateral internal thoracic artery graft s and 236 additional grafts (average 2.6+/-0.6 anastomoses per patient ). There were 515 men (92%) and the average age was 56.9+/-8.8 years. There were 63 diabetic patients (11.3%). During harvesting, the intern al thoracic arteries were always totally skeletonized from the surroun ding tissues without the use of electrocautery. Results. Postoperative complications included reoperation for bleeding, 17 patients (3%), ph renic nerve paresis, 17 patients (3%), acute respiratory distress synd rome, 9 patients (1.6%), digestive complications, 8 patients (1.4%), n eurologic complications, 6 patients (1.1%): and sternal complications, 6 patients (1.1%). No wound complications were observed in diabetic p atients. The hospital mortality rate was 1.6% (9 patients, 2 cardiac c auses). The early patency of internal thoracic artery grafts was 97.9% . Follow-up averages 29+/-20 months. There were 14 late deaths (4 card iac causes). Angina recurred in 51 patients and the maximal stress tes t was abnormal in 47 patients. Conclusion. Bilateral internal thoracic artery grafting with skeletonized harvesting carried low post-operati ve mortality and morbidity and therefore it could be applied routinely without the fear of increased complication rate.