BILATERAL MAMMARY GRAFTING - CLINICAL, FUNCTIONAL AND ANGIOGRAPHIC ASSESSMENT IN 400 CONSECUTIVE PATIENTS

Between October 1985 and September 1991, 400 patients benefited from b ilateral internal mammary artery (BIMA) grafting. Of these, 354 (88.5% ) were male and the average age was 57.4 years. There were 132 (33%) u rgent procedures, 55 in diabetic patients (14%) and 15 in end-stage re nal failures (4%). An average of 3.9 distal anastomoses (AN) per patie nt was undertaken, 2.8 using arterial grafts. Two hundred sixty-nine p atients (67.2%) received exclusively arterial grafts. Right internal m ammary artery (RIMA) grafts were predominantly directed to the left co ronary system (348 AN = 78%) and particularly to the circumflex (CX) a rea. Postoperative myocardial infarction was diagnosed in 16 patients (4%). Reoperation was required for early myocardial ischemia in 12 pat ients (3%) and for excessive bleeding in 23 patients (5.8 %). Sternal complications occurred in 18 patients (4.1 %), 5 in diabetic patients (9 %) and 3 in renal patients (20%). The hospital mortality was 2% (8 patients, 3 cardiac causes). Follow-up averages 37.7 months. Late mort ality was 3 % (12 patients, 4 cardiac causes). Angina recurred in 12 p atients (3.1 %). The maximal stress test at a mean interval of 9 month s was abnormal in 7.4% (21 patients). One hundred eighty-one patients (47%) consented to an angiographic restudy at an average of 13 months postoperatively. Pedicled RIMA patency rates equal those of pedicled L IMA (95.1 vs 96.7, NS) and the grafted vessel does not alter the paten cy rates of IMA AN. A pedicled IMA graft is preferable to a free IMA g raft (96.1 vs 79.6, P < 0.001). The early patency rates of free IMA gr afts and of saphenous grafts do not differ significantly (79.6 vs 84.7 , NS): the former reflect the delicacy of the proximal AN and should s ubsequently behave similar to those of the pedicled AN grafts. Bilater al internal mammary artery grafting is expected to maintain excellent results over the long-term on the condition that it rests on reasonabl e indications and a thoughtful operative strategy.