Jonjev Živojin S, Bjeljac Ilija, Milosavljević Aleksandar M, Todić Mirko, Mrvić Strahinja, Kalinić Novica
Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica, Serbia.
University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina.
J Geriatr Cardiol. 2025 Apr 28;22(4):415-422. doi: 10.26599/1671-5411.2025.04.004.
Bilateral internal mammary arteries (BIMAs) as the most advanced surgical option for coronary artery bypass grafting (CABG) are usually recommended for younger patients without traditional risk factors. This study compares outcomes in propensity score-matched patients aged over 70 years who received BIMAs versus those who received a single internal mammary artery (SIMA).
From 2013 to 2024, 8123 patients underwent primary CABG for multivessel coronary artery disease at our institution. BIMA grafting was performed in 1233 patients (15.17%), with BIMA grafting in 290 patients (3.57%). For BIMA group, the right internal mammary artery was used to revascularize the right coronary artery, while the left internal mammary artery was utilized for the left anterior descending artery. BIMA patients aged over 70 years ( = 79) were compared with SIMA patients ( = 79) using propensity score matching. Primary outcome was all-cause mortality at 30 days and 8 years. Secondary outcomes included length of hospital stay, incidence of postoperative major adverse cardiovascular and cerebrovascular events, sternal wound infection and the need for subsequent percutaneous revascularization.
There was no difference in immediate postoperative primary and secondary outcomes. Mean follow-up was 8.3 ± 1.0 years with an 8-year freedom from death of 67.08% ± 1.1% in the BIMA group versus 58.22% ± 0.9% in the SIMA group ( < 0.05).
BIMAs as grafts can be successfully used in CABG for patients aged 70 years and older. Consequently, the refined techniques for constructing internal mammary artery grafts used in this study challenge traditionally accepted limitations regarding the use of BIMAs.
双侧乳内动脉（BIMAs）作为冠状动脉旁路移植术（CABG）最先进的手术选择，通常推荐用于无传统危险因素的年轻患者。本研究比较了倾向评分匹配的70岁以上接受双侧乳内动脉搭桥术患者与接受单支乳内动脉（SIMA）搭桥术患者的结局。
2013年至2024年，我院8123例患者因多支冠状动脉疾病接受初次CABG。1233例患者（15.17%）接受了双侧乳内动脉搭桥术，其中290例患者（3.57%）接受了双侧乳内动脉搭桥术。对于双侧乳内动脉组，右乳内动脉用于右冠状动脉血运重建，而左乳内动脉用于左前降支动脉。采用倾向评分匹配法，将70岁以上的双侧乳内动脉搭桥术患者（n = 79）与单支乳内动脉搭桥术患者（n = 79）进行比较。主要结局是30天和8年的全因死亡率。次要结局包括住院时间、术后主要不良心血管和脑血管事件的发生率、胸骨伤口感染以及后续经皮血运重建的需求。
术后即刻的主要和次要结局无差异。平均随访8.3±1.0年，双侧乳内动脉搭桥术组8年无死亡生存率为67.08%±1.1%，单支乳内动脉搭桥术组为58.22%±0.9%（P<0.05）。
双侧乳内动脉作为移植物可成功用于70岁及以上患者的CABG。因此，本研究中用于构建乳内动脉移植物的精细技术挑战了传统上关于双侧乳内动脉使用的公认限制。
