[Bimammary coronary artery bypass grafting in women: a retrospective study].

Abstract

Background: The gold standard for revascularization of the anterior descending artery is the use of the left internal mammary artery. The majority of retrospective studies documented better long-term results of using 2 internal mammary arteries for myocardial revascularization as compared with only 1 internal mammary artery. Despite these findings, the number of works devoted to using 2 internal mammary arteries in women for aortocoronary bypass grafting (CABG) is scarce.

Objective: The study was aimed at evaluating the results of using 2 internal mammary arteries for surgical treatment of coronary artery disease in women.

Patients and methods: Between October 2012 and April 2022, we retrospectively analyzed the outcomes in 4905 patients who underwent CABG. Of these, the study enrolled a total of 1085 (39.5%) cases. The inclusion criterion was the use of 2 internal mammary arteries for CABG. The primary endpoint was mortality, with secondary endpoints being myocardial infarction, stroke and wound infections. The mean age was 64.9±14.2 years (from 46 to 80 years), with an average EuroSCORE II of 2.3±1.4.

Results: Overall mortality amounted to 0.5% (5 patients). Operations were performed on-pump with cardioplegia in 55.1% of cases, off-pump in 36.4% of cases, and parallel on-pump in 8.5%. The frequency of procedure-related complications was as follows: postoperative bleeding - 2% (22 patients), wound infection - 1% (11 patients) and stroke - 0.1% (1 patient). The mean intensive care unit length of stay was 1.2±0.7 days. The average hospital stay was 9.8±1.2 days. The median duration of follow-up period amounted to 68.4 months (95% CI 65.1-66.7). The Kaplan-Meier method showed a 36-month survival rate of 94.8% (95% CI 93.1-97.4) and 60-month survival of 85.3% (95% CI 83.2-88.5).

Conclusion: Using 2 internal mammary arteries in women for myocardial revascularization is an effective and safe procedure, demonstrating satisfactory results of surgical treatment of coronary artery disease.