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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 850-856, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DM Cosgrove, BW Lytle, FD Loop, PC Taylor, RW Stewart, CC Gill, LA Golding and M Goormastic
The risk of bilateral internal mammary artery grafting was studied in three
groups of patients who were computer matched for recognized risk factors:
year of operation, age, gender, extent of coronary artery disease, left
ventricular function, completeness of myocardial revascularization, and
history of congestive heart failure. The patient groups differed in the
fact that they received veins only, one internal mammary artery graft, or
two internal mammary artery grafts. The operative mortality rates for these
three groups were 1.8%, 0.3%, and 0.9%, respectively (no significant
difference). Analysis of perioperative morbidity demonstrated no
significant differences except for a slight increase in transfusion
requirements in the group receiving two internal mammary artery grafts (p =
0.04). None of the patients with only vein grafts had wound complications.
One patient in the group with one internal mammary artery graft had a wound
complication (0.03%). Eight patients receiving two internal mammary artery
grafts had wound complications (2.4%) (p = 0.002). The prevalence of wound
complications in patients with diabetes mellitus was 5.7% and in those
without diabetes mellitus, 0.3% (p = 0.01). The prevalence of wound
complications in patients less than 60 years of age was 0.2%, in patients
in their 60s, 1.6%, and in patients older than 70, 3.1% (p = 0.01).
Multivariate logistic regression analysis identified diabetes mellitus and
age and not bilateral internal mammary artery grafting as risk factors for
wound complications. We conclude that bilateral internal mammary artery
grafting does not increase surgical mortality and increases surgical
morbidity by a slight increase in the mean transfusion requirement.
ARTICLES
Does bilateral internal mammary artery grafting increase surgical risk?
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44106.
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