Royal Victoria Hospital, Belfast, UK.
Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Asian Cardiovasc Thorac Ann. 2023 Nov;31(9):781-794. doi: 10.1177/02184923231209364. Epub 2023 Oct 25.
Data on bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) on diabetics were analyzed; This is the only meta-analysis, the last 7 years.
Medline through PubMed/EMBASE/CINHAL and the Cochrane Central Register of Controlled Trials; 179 articles were studied; 19 studies deemed suitable and were included in the analysis.
The mortality was 2.41% for BIMA versus 1.71% for SIMA (odds ratio [OR] = 0.95; 95% confidence interval [CI]: 0.74-1.22). Postoperative reopening for bleeding was higher at 3.75% for BIMA versus 2.91% for SIMA (OR = 1.49; 95% CI: 1.15-1.93). The incidence of MI was 0.87% for BIMA versus 0.83% for SIMA (OR = 0.73; 95% CI: 0.37-1.44). Deep sternal wound infection was 3.02% for BIMA and 1.95% for SIMA (OR = 1.57; 95% CI: 1.26-1.95). When skeletonized, the incidence of DSWI was 2.5% for BIMA versus 2.41% for SIMA. There was a significant difference at 5-year survival favoring the BIMA, 85.15% BIMA versus 80.77% SIMA (OR = 1.79; 95% CI: 1.60-2.01). The 10-year overall survival was 74.04% BIMA versus 61.57% SIMA (OR = 1.79; 95% CI: 1.61-1.98). The 15-year survival was 47.08% for BIMA versus 37.06% for SIMA (OR = 1.69; 95% CI: 1.52-1.88).
Postoperative bleeding was higher in BIMA group. Bilateral internal mammary artery in diabetic patients should be carried out in a skeletonize fashion, to reduce DSWI. There is a survival benefit of using BIMA in diabetics within 5 years of surgery; it remains significant up to 15 years.
分析糖尿病患者双侧内乳动脉（BIMA）与单根内乳动脉（SIMA）的相关数据；这是最近 7 年唯一的一项荟萃分析。
通过 Medline（PubMed/EMBASE/CINHAL）和 Cochrane 对照试验中心注册库检索；研究了 179 篇文章，纳入了 19 项符合条件的研究进行分析。
BIMA 组的死亡率为 2.41%，SIMA 组为 1.71%（比值比 [OR] = 0.95；95%置信区间 [CI]：0.74-1.22）。BIMA 组术后因出血而再次开放的发生率为 3.75%，SIMA 组为 2.91%（OR = 1.49；95% CI：1.15-1.93）。BIMA 组心肌梗死的发生率为 0.87%，SIMA 组为 0.83%（OR = 0.73；95% CI：0.37-1.44）。BIMA 组深部胸骨伤口感染的发生率为 3.02%，SIMA 组为 1.95%（OR = 1.57；95% CI：1.26-1.95）。当内乳动脉被骨骼化时，BIMA 组深部胸骨伤口感染的发生率为 2.5%，SIMA 组为 2.41%。BIMA 组 5 年生存率显著高于 SIMA 组，分别为 85.15%和 80.77%（OR = 1.79；95% CI：1.60-2.01）。10 年总生存率分别为 74.04%和 61.57%（OR = 1.79；95% CI：1.61-1.98）。15 年生存率分别为 47.08%和 37.06%（OR = 1.69；95% CI：1.52-1.88）。
BIMA 组术后出血较多。糖尿病患者应采用骨骼化方式进行双侧内乳动脉，以降低深部胸骨伤口感染的发生率。在手术后 5 年内，使用 BIMA 对糖尿病患者有生存获益，这种获益在 15 年内仍然显著。
