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. 2021 Jan 6;16(1):2.
doi: 10.1186/s13019-020-01380-z.

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

Zengqiang Han  1 , Guodong Zhang  1 , Shenglong Chen  1 , Gang Liu  1 , Yu Chen  2
Affiliations

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

Zengqiang Han et al. J Cardiothorac Surg. .

Abstract

Background: A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA.

Methods: There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared.

Results: There was no difference in the early postoperative death and major complications between group I and Group II(P>0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P>0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value (71.4 ± 7.8 vs 61.8 ± 18.1,P = 0.025). The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup (3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent.

Conclusions: The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

Keywords: Coronary artery bypass graft; Internal mammary arteries; Transit time flow measurement.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
In situ RIMA to right coronary artery or posterior descending artery with in situ LIMA to left anterior descending artery. LIMA, left internal mammary artery; RIMA, right internal mammary artery
Fig. 2
Fig. 2
a In situ RIMA to LAD with in situ LIMA to diagonal branch. b In situ RIMA to LCX with in situ LIMA to LAD. LAD, left anterior descending artery; LIMA, left internal mammary artery; RIMA, right internal mammary artery; TTFM, transit-time flow measurement
See this image and copyright information in PMC

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