Bilateral skeletonized IMAs used as "in situ" grafts for different coronary territories: long-term propensity matching study.

IF 0.6 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-09-01 Epub Date: 2025-07-04 DOI:10.1007/s12055-025-01979-8

Živojin Jonjev, Ilija Bjeljac, Aleksandar Milosavljević, Mirko Todić, Strahinja Mrvić, Novica Kalinić

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引用次数: 0

Abstract

Introduction: 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).

Methods: 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.

Results: 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%, p < 0.05).

Conclusion: 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.

Graphic abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01979-8.

查看原文本刊更多论文

双侧骨化ima用作不同冠状动脉区域的原位移植物：长期倾向匹配研究。

简介：双侧乳腺内动脉（BIMAs）是冠状动脉搭桥术（CABG）中最先进的手术选择。本研究比较了在不同冠状动脉区域接受骨化bima原位移植物的患者和接受单乳内动脉（SIMA） CABG的患者的结果。方法：2013年至2023年间，在我院接受了7543例多支冠状动脉疾病冠脉搭桥治疗的患者。BIMA移植1133例（15.02%），原位BIMA移植283例（3.75%）。右冠状动脉采用右乳内动脉（RIMA），左前降支采用左乳内动脉（LIMA）。倾向评分匹配每组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、术后主要心脑血管不良事件（MACCE）发生率、胸骨伤口感染以及后续血运重建的需要。结果：两组患者均无术后30天死亡率、围手术期MACCE、胸骨深创面感染。平均随访时间为9.78±0.62年。原位BIMA组的10年生存率（86.07±3.0%）明显高于SIMA组（78.6±4.1%），p结论：骨化BIMA移植比SIMA移植提高了长期生存率，消除了传统BIMA使用的局限性。这些发现支持BIMA移植在CABG中的广泛应用。图片摘要：补充资料：在线版本包含补充资料，可在10.1007/s12055-025-01979-8获得。

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来源期刊

Indian Journal of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

1.20

自引率

14.30%

发文量

141

期刊介绍： The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.