[In coronary surgery can both internal mammary arteries be used systematically? Apropos of 560 patients]. / En chirurgie coronaire l'utilisation des deux artères mammaires internes peut-elle être systématique? A propos de 560 patients.

The grafts commonly used in coronary bypass surgery are the left internal mammary artery and the saphenous veins of the legs: the use of both internal mammary arteries, with potential long-term benefits, is only justified if the operative risk is not increased. Since 1987, the authors use both internal mammary arteries systematically in patients under 70 years of age and in good general condition. The retrospective analysis of 560 patients having undergone this surgery from 1987 to 1994 was undertaken to determine if this surgical option is justified without increased operative risk. The dissection of the mammary arteries is performed in a special manner by skeletonization technique. The total hospital complication rate was 12% with 9 deaths in the first 30 postoperative days (1.6%). Mediastinitis was observed in 6 patients (1.1%) Early angiographic controls showed a patent mammary graft rate of 98%. The use of both internal mammary arteries does not therefore increase postoperative morbidity or mortality. It may be proposed systematically in patients in good general condition and may provide long-term benefits in graft patency rates.

Bilateral skeletonized mammary artery grafting: experience with 560 consecutive patients.

OBJECTIVE: To test the hypothesis that the skeletonized technique of harvesting the internal thoracic artery improves the surgical results of bilateral internal thoracic artery grafting, we reviewed our 7-year experience with this technique. METHODS: Between July 1987 and December 1994, 560 patients received bilateral internal thoracic artery grafts and 236 additional grafts (average 2.6 +/- 0.6 anastomoses per patient). There were 515 men (92%) and the average age was 56.9 +/- 8.8 years. There were 63 diabetic patients (11.3%). During harvesting, the internal thoracic arteries were always totally skeletonized from the surrounding tissues without the use of electrocautery. RESULTS: Postoperative complications included reoperation for bleeding, 17 patients (3%), phrenic nerve paresis, 17 patients (3%), acute respiratory distress syndrome, 9 patients (1.6%), digestive complications, 8 patients (1.4%), neurologic complications, 6 patients (1.1%), and sternal complications, 6 patients (1.1%). No wound complications were observed in diabetic patients. The hospital mortality rate was 1.6% (9 patients, 2 cardiac causes). The early patency of internal thoracic artery grafts was 97.9%. Follow-up averages 29 +/- 20 months. There were 14 late deaths (4 cardiac causes). Angina recurred in 51 patients and the maximal stress test was abnormal in 47 patients. CONCLUSION: Bilateral internal thoracic artery grafting with skeletonized harvesting carried low post-operative mortality and morbidity and therefore it could be applied routinely without the fear of increased complication rate.