The Clinical Application Of Bilateral Internal Mammary Artery In Coronary Artery Bypass Grafting

Research Objective:The left internal mammary artery has become the most commonly used vascular material for coronary artery bypass grafting.With the deepening of studies,the advantage of the right internal mammary artery becomes increasingly evident.However,the utilization rate of bilateral internal mammary artery is still low in the whole country and the whole world.This study analyzes the related indexes and follow-up results of bilateral and unilateral internal mammary artery bypass surgery in order to provide more clinical evidence for the use of bilateral internal mammary artery.Research Methods:This study is a retrospective study whose subjects are the coronary artery bypass grafting patients who underwent coronary artery bypass surgeries at the heart center of Qingdao municipal hospital from May 2016 to May 2018.A total of 110 patients were included and randomly divided into 2 groups:bilateral internal mammary artery group(BIMA group)and single internal mammary artery group(SIMA group),with 55 cases in each group.The bilateral internal mammary artery group:Coronary artery bypass grafting was performed without extracorporeal circulation by using bilateral skeletonized internal mammary artery.In the surgeries of some patients,the right internal mammary artery was dissociated and anastomosed with the left internal mammary artery in Y-type,and then bypass was performed.If the vessel is still not long enough,the great saphenous vein will be used.The single internal mammary artery group:The left skeletonized internal mammary artery was used for coronary artery bypass grafting without extracorporeal circulation.If the vessel is still not long enough,the great saphenous vein will be used.Recording and analyzing the clinical data of perioperative patients:preoperative indicators including gender,age,body mass index[weight(kg)/height(m)~2],history of hypertension,diabetes,cerebrovascular disease(CVD)history,history of cardiac arrhythmias,cardiac function(NYHA classification)?-?level,left ventricular ejection fraction(LVEF),EuroSCORE.Intraoperative indicators include operation time,number of bypass,blood flow and pulsatility index,and the use of intra-aortic balloon pump during the operation.Postoperative indicators include in-hospital death,postoperative chest complications,postoperative mechanical ventilation time,ICU residence time and length of stay in hospital,and follow-up after discharge.Research Results:There was no statistically significant difference in preoperative indicators between the two groups,and there was statistically significant difference in operative time between the two groups(BIMA group:293.18±31.01min,SIMA group:262.85±23.92min,P<0.001),but the number of grafts(BIMA group:3.71±0.94,SIMA group:3.62±0.93,P=0.611),pulsatility index(right internal mammary artery grafts:2.54±0.79,left internal mammary artery grafts:2.44±0.72,P=0.343),intraoperative intra-aortic ballon pump(IABP)(BIMA group:5(9.1),SIMA group:6(10.9),P=0.751),in-hospital death(BIMA group:0,SIMA group:0,P=NS),postoperative chest complications(BIMA group:1(1.8),SIMA group:1(1.8),P>0.999),postoperative mechanical ventilation time(BIMA group:15.29±6.09h,SIMA group:14.78±6.42h,P=0.67).There was no significant difference in ICU residence time(BIMA group:2.84±1.32d,SIMA group:2.65±1.28d,P=0.464)or length of stay in hospital(BIMA group:15.71±4.20d,SIMA group:15.44±4.49d,P=0.743).In each of the two groups,there was one patient presenting poor sternal union.After re-fixation,all patients healed well in the later follow-up,and no new cases of poor sternal union occurred in the later follow-up.Three months after follow-up,there were three cases of angina pectoris in SIMA group and two cases of angina pectoris in BIMA group,with no recurrence of myocardial infarction,no secondary operation or death.Conclusion:1.Bilateral internal mammary artery is safe and feasible in coronary artery bypass grafting;2.There is no statistical difference in intraoperative graft patency between the right internal mammary artery as the bridging vessel and the left internal mammary artery;3.There is no statistically significant difference in adverse events such as poor sternal union between the bilateral and single internal mammary artery groups by the method of freeing internal mammary arteries through skeletal methods;4.The operation time of freeing bilateral internal mammary artery is slightly longer than that of single internal mammary artery.