Federal State Budgetary Institution, Federal Centers of High Medical Technologies, Health Ministry, Kaliningrad, Russian Federation.
Asian Cardiovasc Thorac Ann. 2021 Oct;29(8):758-762. doi: 10.1177/0218492321990764. Epub 2021 Jan 21.
The gold standard for coronary artery bypass grafting to the left anterior descending artery is use of the left internal mammary artery. Better long-term survival has been reported using bilateral internal mammary arteries compared to left internal mammary artery only, but many surgeons are reluctant to employ bilateral internal mammary arteries in coronary artery bypass grafting. This study aimed to evaluate the effectiveness and safety of bilateral internal mammary artery use.
From 2014 to 2017, 1703 patients underwent coronary artery bypass grafting in our institute. Of these, 772 met the inclusion criteria and were randomly assigned to receive bilateral ( = 387) or left ( = 385) internal mammary artery grafts. The mean age was 67.1 ± 6.0 years (range 48-85 years) and 474 (61.4%) were male. The mean number of diseased vessels was 3.1 ± 0.9, and mean EuroSCORE II was 3.4% ± 1.1%.
Hospital mortality was 1.2% in the left internal mammary artery group vs. 1.8% in the bilateral internal mammary artery group ( = 0.55). There was no difference in procedure-related complications between groups. Mean follow-up was 65.9 months. Survival in the bilateral internal mammary artery group at 1, 3, and 5 years was 98.7%, 98.7%, and 94.8% vs. 98.1%, 98.1%, and 90.9%, respectively, in the left internal mammary artery group ( = 0.63).
Application of bilateral internal mammary arteries in coronary artery bypass grafting is safe and effective, with comparable midterm results to those with the left internal mammary artery only.
左前降支冠状动脉旁路移植术的金标准是使用左内乳动脉。与仅使用左内乳动脉相比，使用双侧内乳动脉可提高长期生存率，但许多外科医生不愿意在冠状动脉旁路移植术中使用双侧内乳动脉。本研究旨在评估使用双侧内乳动脉的有效性和安全性。
2014 年至 2017 年，我院共对 1703 例患者进行了冠状动脉旁路移植术。其中，772 例符合纳入标准，并随机分为接受双侧（n=387）或左侧（n=385）内乳动脉移植。患者平均年龄为 67.1±6.0 岁（48-85 岁），其中 474 例（61.4%）为男性。平均病变血管数为 3.1±0.9，平均 EuroSCORE II 为 3.4%±1.1%。
左侧内乳动脉组的院内死亡率为 1.2%，双侧内乳动脉组为 1.8%（=0.55）。两组间手术相关并发症无差异。平均随访时间为 65.9 个月。双侧内乳动脉组在 1、3 和 5 年的生存率分别为 98.7%、98.7%和 94.8%，左侧内乳动脉组分别为 98.1%、98.1%和 90.9%（=0.63）。
在冠状动脉旁路移植术中应用双侧内乳动脉是安全有效的，其中期结果与仅使用左内乳动脉相似。
