BILATERAL MAMMARY ARTERY GRAFTING - AVOIDANCE OF COMPLICATIONS WITH EXTENDED USE

This study was undertaken to more clearly define the operative risks a nd appropriate strategies for the selection of patients who might be c andidates for bilateral internal mammary artery grafting. A review of the 674 patients who underwent this procedure was performed over a 10- year period from January 1982 through 1991. These patients represented 5% of the 12,824 patients who underwent bypass grafting during this p eriod. The mean patient age was 54 +/- 9.4 years, and 92% of the patie nt were male. Diabetes was present in 17.5%, with 24% of this group in sulin dependent. The ejection fraction was less than 0.50 in 26.7% and 14% had had previous bypass procedures. Hospital mortality was 1.9% ( n = 13). Hospital morbidity included wound infection in 3.6%, reoperat ion for bleeding in 2.1%, and stroke in 1.6%. Postoperative intraaorti c balloon pump support was necessary in 2.8%. Univariate and multivari ate analysis revealed that advanced age, an emergent operative status, and the number of diseased vessels (especially left main obstruction) were predictors of hospital death. Except for wound infection (9.3% v ersus 2.5%) and length of hospital stay (10.8 +/- 11.8 days versus 8.8 +/- 7.6 days), the complications in diabetics were similar to those i n patients without diabetes, respectively. At 5 years, freedom from de ath, death or infarctions, and death, myocardial infarction, or corona ry reoperation was 90%, 70%, and 62%, respectively. The only significa nt multivariate correlates of long-term survival were diabetes and reo perative surgery.