Bilateral versus single internal mammary artery use in coronary artery bypass grafting: a propensity matched analysis

Ying Yan Zhu, Michael Seco, Stella R. Harris, Michalis Koullouros, Fabio Ramponi, Michael Wilson, Paul G. Bannon, Michael P. Vallely

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. Methods: From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. Results: Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p < 0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3% BIMA vs. 0.9% SIMA, p = 0.48) and deep sternal wound infection (1.1% BIMA vs. 0.9% SIMA, p = 0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6% vs. 1.3%, p = 0.077). The rates of red blood cell transfusions (27.4% vs. 27%, p = 0.217), other blood product transfusions (18% vs. 20%, p = 0.217), and reoperation for bleeding (2.9% vs. 2.1%, p = 0.349) were similar. Conclusions: Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.

LanguageEnglish
Pages807-813
Number of pages7
JournalHeart Lung and Circulation
Volume28
Issue number5
DOIs
Publication statusPublished - May 2019

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Mammary Arteries
Coronary Artery Bypass
Wound Infection
Propensity Score
Mortality
Morbidity
Transplants
Erythrocyte Transfusion
Reoperation
Blood Transfusion
Wound Healing

Keywords

  • Arterial revascularisation
  • Coronary artery bypass surgery
  • Deep sternal wound infection

Cite this

Zhu, Y. Y., Seco, M., Harris, S. R., Koullouros, M., Ramponi, F., Wilson, M., ... Vallely, M. P. (2019). Bilateral versus single internal mammary artery use in coronary artery bypass grafting: a propensity matched analysis. Heart Lung and Circulation, 28(5), 807-813. https://doi.org/10.1016/j.hlc.2018.03.022
Zhu, Ying Yan ; Seco, Michael ; Harris, Stella R. ; Koullouros, Michalis ; Ramponi, Fabio ; Wilson, Michael ; Bannon, Paul G. ; Vallely, Michael P. / Bilateral versus single internal mammary artery use in coronary artery bypass grafting : a propensity matched analysis. In: Heart Lung and Circulation. 2019 ; Vol. 28, No. 5. pp. 807-813.
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title = "Bilateral versus single internal mammary artery use in coronary artery bypass grafting: a propensity matched analysis",
abstract = "Background: Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. Methods: From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. Results: Overall, 29{\%} of procedures were performed off pump, with a greater proportion in the BIMA group (43{\%} vs. 21{\%}, p < 0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3{\%} BIMA vs. 0.9{\%} SIMA, p = 0.48) and deep sternal wound infection (1.1{\%} BIMA vs. 0.9{\%} SIMA, p = 0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6{\%} vs. 1.3{\%}, p = 0.077). The rates of red blood cell transfusions (27.4{\%} vs. 27{\%}, p = 0.217), other blood product transfusions (18{\%} vs. 20{\%}, p = 0.217), and reoperation for bleeding (2.9{\%} vs. 2.1{\%}, p = 0.349) were similar. Conclusions: Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.",
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Zhu, YY, Seco, M, Harris, SR, Koullouros, M, Ramponi, F, Wilson, M, Bannon, PG & Vallely, MP 2019, 'Bilateral versus single internal mammary artery use in coronary artery bypass grafting: a propensity matched analysis', Heart Lung and Circulation, vol. 28, no. 5, pp. 807-813. https://doi.org/10.1016/j.hlc.2018.03.022

Bilateral versus single internal mammary artery use in coronary artery bypass grafting : a propensity matched analysis. / Zhu, Ying Yan; Seco, Michael; Harris, Stella R.; Koullouros, Michalis; Ramponi, Fabio; Wilson, Michael; Bannon, Paul G.; Vallely, Michael P.

In: Heart Lung and Circulation, Vol. 28, No. 5, 05.2019, p. 807-813.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Bilateral versus single internal mammary artery use in coronary artery bypass grafting

T2 - Heart Lung and Circulation

AU - Zhu, Ying Yan

AU - Seco, Michael

AU - Harris, Stella R.

AU - Koullouros, Michalis

AU - Ramponi, Fabio

AU - Wilson, Michael

AU - Bannon, Paul G.

AU - Vallely, Michael P.

PY - 2019/5

Y1 - 2019/5

N2 - Background: Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. Methods: From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. Results: Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p < 0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3% BIMA vs. 0.9% SIMA, p = 0.48) and deep sternal wound infection (1.1% BIMA vs. 0.9% SIMA, p = 0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6% vs. 1.3%, p = 0.077). The rates of red blood cell transfusions (27.4% vs. 27%, p = 0.217), other blood product transfusions (18% vs. 20%, p = 0.217), and reoperation for bleeding (2.9% vs. 2.1%, p = 0.349) were similar. Conclusions: Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.

AB - Background: Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. Methods: From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. Results: Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p < 0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3% BIMA vs. 0.9% SIMA, p = 0.48) and deep sternal wound infection (1.1% BIMA vs. 0.9% SIMA, p = 0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6% vs. 1.3%, p = 0.077). The rates of red blood cell transfusions (27.4% vs. 27%, p = 0.217), other blood product transfusions (18% vs. 20%, p = 0.217), and reoperation for bleeding (2.9% vs. 2.1%, p = 0.349) were similar. Conclusions: Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.

KW - Arterial revascularisation

KW - Coronary artery bypass surgery

KW - Deep sternal wound infection

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U2 - 10.1016/j.hlc.2018.03.022

DO - 10.1016/j.hlc.2018.03.022

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