Routine use of bilateral skeletonized internal mammary arteries for myocardial revascularization

Background. Complete arterial myocardial revascularization without the use of saphenous veins grafts was primarily performed on selected patient popul ations such as the young and nondiabetic. In a recently developed surgical technique, the internal mammary artery is dissected gently as a longer skel etonized artery, providing greater versatility for complete arterial revasc ularization, without saphenous veins grafts. Methods. We prospectively evaluated the impact of the routine use of double skeletonized internal mammary artery in 472 patients who underwent coronar y artery bypass grafting between April 1996 and Tune 1997. Their average ag e was 65 years (30 to 87 years), 383 (83%) were men, and 89 (17%) women. On e hundred sixty-nine (36%) of the patients were older than 70 years, and 14 5 (31%) were diabetic. The average number of grafts was 3.2 per patient (tw o to six grafts). Results. Operative mortality was 1.7% (n = 8). The mortality of urgent and elective patients was 0.7% (3 of 410 patients), and that of emergency opera tions was 8.1% (5 of 62 patients; p < 0.01). There were three (0.6%) periop erative infarcts, and 6 patients (1.3%) sustained strokes. Sternal wound in fection occurred in 8 patients (1.7%). Postoperative follow-up (1 to 25 mon ths) was available in 462 patients (99%). Two-year actuarial survival was 9 6.8%, and 92% of the surviving patients are well and free of angina. Neithe r diabetes mellitus nor old age (>70 years) were significant independent pr edictors of any early or late untoward events. None of the 70 diabetic pati ents more than 65 years of age developed sternal wound infection. Chronic l ung disease was found to be the only independent predictor for sternal infe ctions. Conclusions. Routine use of bilateral skeletonized internal mammary artery is a safe replacement for the current myocardial revascularization techniqu e even in the old and diabetic patients. (C) 1999 by The Society of Thoraci c Surgeons.