Comparison between Bilateral Internal Mammary Artery Graft and LIMAG in Patients Undergoing CA Bypass Grafting

Abstract

Background: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over Left internal mammary artery for coronary artery bypass grafting (CABG). However, there are still uncertainties about which surgical approach is the best one to use with BIMA grafting. Objective: To compare Bilateral Internal Mammary Artery (BIMA) Grafting with Left Internal Mammary Artery (LIMA) Grafting during Coronary Artery Bypass Grafting (CABG) in terms of early mortality and sternal wound infections. Materials & Methods Randomized: control trialtechnique enrolled. The study was conducted at the Cardiac Surgery Department, King Edward Medical University (KEMU), Mayo Hospital Lahore Results: Total 96patients undergoing CABG were included in this study. Patients were randomly divided into 2 groups; each group contains 48 patients. Group A included patients having Left IMA to LAD; second and third graft by Great Saphenous Vein and Group B included patients having Bilateral Internal Mammary Arteries with Left IMA to LAD or OM and Right IMA to RCA, LAD or Ramus Intermedius. The superficial and deep sternal wound infections was recorded along with the different risk factors including diabetes, obesity, hypertension, smoking and use of inotropes intra-operatively and post operatively. The incision site over the sternum was being evaluated on daily basis throughout the stay of the patients (from 5–8 days). Diagnosis of Sternal infections was based on the presence of positive cultures, dehiscence of the sternum incision, fever, redness pain, and infected (purulent) secretions. Sternal instability and discharge, ventilation time, length of ICU stay, chest drainage, re-exploration and length of hospital stay was also recorded. Results:Not any of the patients included in these two treatment groups suffered from mortality (LIMA: 0%, BIMA: 0%). Deep sternal wound infection [LIMA: 4.17% & BIMA: 6.25%, p-value=0.646] and superficial wound infection [LIMA: 4.17% & BIMA: 6.25%, p-value=0.646] did not show any statistically significant association towards both grafts type. Patients who underwent BIMA grafting suffered from higher in hospital stay as compared to patients who underwent LIMAgrafting. i.e. [LIMA: 7.02 & BIMA: 8.02, P value = 0.000] Conclusion: Results of the study showed no significant difference for deep sternal wound infection and superficial wound infection between the two grafts BIMA and LIMA. However, patients who underwent BIMA grafting had significantly higher hospital stay as compared to patients who underwent LIMA grafting. Keywords: Bilateral, Internal, Mammary Artery, Grafting, Left, Internal Mammary Artery, Coronary Artery, Bypass, Grafting, Mortality, Sternal wound infections.