Jonjev Živojin, Bjeljac Ilija, Milosavljević Aleksandar, Todić Mirko, Mrvić Strahinja, Kalinić Novica
Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Institutski Put 4, 21204 Sremska Kamenica, Serbia.
Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska Bosnia and Herzegovina.
Indian J Thorac Cardiovasc Surg. 2025 Sep;41(9):1144-1152. doi: 10.1007/s12055-025-01979-8. Epub 2025 Jul 4.
Bilateral internal mammary arteries (BIMAs) are the most advanced surgical option for coronary artery bypass grafting (CABG). This study compares outcomes between patients receiving skeletonized BIMAs as in situ grafts for different coronary territories and those undergoing CABG with a single internal mammary artery (SIMA).
Between 2013 and 2023, 7543 patients underwent CABG for multivessel coronary artery disease at our institution. BIMA grafting was performed in 1133 patients (15.02%), with in situ BIMA grafting in 283 patients (3.75%). The right internal mammary artery (RIMA) was used for the right coronary artery, and the left internal mammary artery (LIMA) for the left anterior descending artery. Propensity score matching yielded 280 patients in each group for comparison. Primary outcomes were 30-day and 10-year all-cause mortality. Secondary outcomes included length of hospital stay, incidence of postoperative major adverse cardiovascular and cerebrovascular events (MACCE), sternal wound infection, and the need for subsequent revascularization.
There was no 30-day postoperative mortality, perioperative MACCE, or deep sternal wound infection in either group. Mean follow-up was 9.78 ± 0.62 years. The 10-year survival rate was significantly higher in the in situ BIMA group (86.07 ± 3.0%) compared to the SIMA group (78.6 ± 4.1%, < 0.05).
Skeletonized BIMA grafting improves long-term survival compared to SIMA grafting, rendering traditionally accepted limitations for BIMA usage irrelevant. These findings support the broader adoption of BIMA grafting in CABG.
The online version contains supplementary material available at 10.1007/s12055-025-01979-8.
双侧乳内动脉（BIMAs）是冠状动脉旁路移植术（CABG）中最先进的手术选择。本研究比较了接受骨骼化双侧乳内动脉作为不同冠状动脉区域原位移植的患者与接受单支乳内动脉（SIMA）进行冠状动脉旁路移植术患者的结局。
2013年至2023年期间，我院7543例患者因多支冠状动脉疾病接受了冠状动脉旁路移植术。1133例患者（15.02%）接受了双侧乳内动脉移植，其中283例患者（3.75%）接受了原位双侧乳内动脉移植。右乳内动脉（RIMA）用于右冠状动脉，左乳内动脉（LIMA）用于左前降支动脉。倾向评分匹配后，每组有280例患者进行比较。主要结局为30天和10年全因死亡率。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（MACCE）发生率、胸骨伤口感染以及后续血运重建的需求。
两组术后30天均无死亡率、围手术期MACCE或深部胸骨伤口感染。平均随访时间为9.78±0.62年。原位双侧乳内动脉组的10年生存率（86.07±3.0%）显著高于单支乳内动脉组（78.6±4.1%，P<0.05）。
与单支乳内动脉移植相比，骨骼化双侧乳内动脉移植可提高长期生存率，使传统上接受的双侧乳内动脉使用限制不再相关。这些发现支持在冠状动脉旁路移植术中更广泛地采用双侧乳内动脉移植。
在线版本包含可在10.1007/s12055-025-01979-8获取的补充材料。
