Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2017; 9(4): 339-346
Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.339
Bilateral vs unilateral internal mammary revascularization in patients with left ventricular dysfunction
Batric Popovic, Pablo Maureira, Yves Juilliere, Nicolas Danchin, Damien Voilliot, Fabrice Vanhuyse, Jean Pierre Villemot
Batric Popovic, Yves Juilliere, Damien Voilliot, Département de Cardiologie, CHU Nancy, F-54000 Nancy, France
Pablo Maureira, Fabrice Vanhuyse, Jean Pierre Villemot, Service de Chirurgie des Maladies, Cardiovasculaires et Transplantations, CHU Nancy, F-54000 Nancy, France
Nicolas Danchin, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP) Université Paris Descartes, F-75000 Paris, France
Author contributions: Popovic B was responsible for study design, concept and test of the manuscript; Danchin N analysed the data and helped to draft the manuscript; Maureira P, Juilliere Y, Voilliot D, Vanhuyse F and Villemot JP helped to draft the manuscript.
Institutional review board statement: Our retrospective study of patients’ files was approved by the Commission Nationale Informatique et Libertés (CNIL), in keeping with French law for single-center usual care observational studies.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: None of the authors have any conflict of interest regarding the content of this article.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Batric Popovic, MD, PhD, Département de Cardiologie, CHU Nancy, rue de Morvan, F-54000 Nancy, France. b.popovic@chu-nancy.fr
Telephone: +33-38-3153232 Fax: +33-38-3154226
Received: October 14, 2016
Peer-review started: October 17, 2016
First decision: December 15, 2016
Revised: December 29, 2016
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: April 26, 2017
Processing time: 196 Days and 4.6 Hours
Abstract
AIM

To investigate the survival benefit of bilateral internal mammary artery (BIMA) grafts in patients with left ventricular dysfunction.

METHODS

Between 1996 and 2009, we performed elective, isolated, primary, multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery (LIMA)-saphenous venous grafting (SVG).

RESULTS

The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups (7.8% vs 10.3%, P = 0.49). Early postoperative morbidity included myocardial infarction (4.2% vs 3.8%, P = 0.80), stroke (1.2% vs 3.8%, P = 0.14), and mediastinitis (5.3% vs 2.3%, P = 0.11). At 8-year follow-up, Kaplan-Meier-estimated survival (74.2% vs 58.9%, P = 0.02) and Kaplan-Meier-estimated event-free survival (all cause deaths, myocardial infarction, stroke, target vessel revascularization, heart failure) (61.7% and 41.1%, P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival (P = 0.40) and event-free survival (P = 0.13) in comparison with LIMA-SVG use.

CONCLUSION

Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.

Keywords: Bilateral internal mammary artery grafting; Heart failure; Coronary artery disease

Core tip: This study reports a daily practice observation of patients with multivessel coronary artery disease and left ventricular (LV) dysfunction undergoing surgical revascularization. We evaluate the periprocedural safety of bilateral internal mammary artery grafting (BIMA) in this high risk population and its long-term survival benefit compared with the left internal mammary artery grafting (LIMA) to left anterior descending artery with additional saphenous venous grafting (SVG). Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with LV dysfunction but there was no survival difference in our follow up in comparison with LIMA-SVG use.