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DOI: 10.1055/s-0036-1571501
Off-pump Revascularization with Bilateral Mammary Artery -Single Center Proof of Concept after 5 Years
Objective: Off-pump myocardial revascularization using bilateral mammary artery (BIMA) is a promising concept in cardiac surgery during the last years. Beside proven benefits toward off-pump surgery, there is an ongoing debate, whether single mammary artery revascularization (SIMA) is superior to the BIMA revascularization in the short and long term course.
Methods: We analyzed in a single center retrospective study propensity score (PS) adjusted data from 3233 patients from July 2009 to August 2014. Myocardial revascularization was performed using either single LIMA to LAD and further saphenous vein grafts (group I; n = 2558) or BIMA (IMA to LAD and RIMA to all other coronary vessels) (group II; n = 675). All procedures were performed in off-pump non-aortic touch technique. Primary endpoints were PS-adjusted 30 day mortality and 5-year survival. Secondary endpoints were operative time, number of anastomosis, postoperative recatheterization and the incidence of wound infection and mediastinitis.
Results: PS-adjusted 30-day mortality did not differ significantly in the cohort (group I: 1.6% and group II: 0.3%; odds ratio (reference: group I) = 0.45 (95%CI: 0.1;1.93); p = 0.28). The 5-year survival was 91.8% in group I and 97.2% in group II. The relative risk of 5-year mortality for group II (reference: group I) was = 0.98 (95%CI 0.6–1.6); p = 0.93). Median operative time was significantly shorter in group I than in group 2 (187 minute [95%CI: 161; 215] versus 231 minute [95%CI: 202; 260]; p< 0,001), whereas significantly more anastomoses were performed in the latter (3 [IQR: 3;4] versus 3 [IQR:2;3]; p = 0.001). The incidence of PS-adjusted wound infection (group I: 0.8% and group II: 0.7%; p = 0.9) and mediastinitis (group I: 0.5% and group II 0.1%; p = 0.5) was similar. Moreover, PS-adjusted postoperative recatheterization did not differ significantly between groups (group I: 4.9% and group II 3.9%; p = 0.14).
Conclusion: Off-pump revascularization with BIMA can be performed with the same outcome as the during decades established concept of SIMA revascularization, according to low 30-day mortality and excellent 5-year survival. Compared with SIMA, BIMA revascularization is not inferior toward wound infection and mediastinitis. The combined use of BIMA with off-pump surgery does not reduce the concept of complete revascularization.