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Thorac Cardiovasc Surg 2017; 65(04): 278-285
DOI: 10.1055/s-0037-1598028
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

The Use of Bilateral Internal Mammary Artery Grafting in Different Degrees of Obesity

Yasser Y. Hegazy
1   Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany
2   Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
,
Wael Hassanein
2   Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
,
Jürgen Ennker
1   Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany
3   School of Medicine, Faculty of Health, University of Witten Herdecke, Witten, Germany
,
Noha Keshk
1   Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany
,
Stefan Bauer
1   Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany
,
Ralf Sodian
1   Department of Cardiac Surgery, Mediclin Heart Institute, Lahr/Baden, Germany
› Author Affiliations
Further Information

Publication History

19 October 2016

09 December 2016

Publication Date:
22 January 2017 (online)

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Abstract

Background Obesity is a limiting factor for the use of bilateral internal mammary arteries (BIMAs). Therefore, we assessed the safety of their use in different degrees of obesity.

Patients and Methods We studied two groups of patients with obesity using propensity matching. The first group received single internal mammary artery and saphenous vein grafts (SIMA group, 526 patients) and the second group received bilateral internal mammary arteries (BIMA group, 526 patients). Patients were classified further according to their body mass index (BMI) into overweight (BMI = 25–29.9 kg/m2), obese (BMI = 30–34.9 kg/m2), and severely obese (BMI ≥ 35 kg/m2).

Results Preoperative data were similar regarding age (62.78 ± 9.96 vs. 62.98 ± 9.66 years; p = 0.734), female sex (17.5 vs. 18.6%; p = 0.631), diabetes mellitus (26.3 vs. 27.2%; p = 0.74), EuroSCORE (3.21 ± 2.23 vs. 3.18 ± 2.41; p = 0.968), and COPD (16 vs. 16%; p = 1). No significant differences were noticed between the two groups regarding the number of peripheral anastomoses (3.09 ± 0.84 vs. 3.12 ± 0.83; p = 0.633), myocardial infarction (1.7 vs. 1.7%; p = 1), reexploration (1.3 vs. 2.1%; p = 0.34), deep sternal wound infection (DSWI) (2.1 vs. 2.9%; p = 0.43), and 30-day mortality (0.8 vs. 1.1%; p = 0.53). Multivariate analysis identified BMI and intensive care unit stay as independent predictors for DSWI. However, postoperative blood loss (694.56 ± 631.84 vs. 811.67 ± 688.73 mL; p < 0.001) and the incidence of pneumothorax (1 vs. 2.7%; p = 0.037) were higher in BIMA group.

Conclusion Patients with obesity can benefit from BIMA grafting. However, postoperative blood loss and the incidence of pneumothorax can be higher using this technique.

Keywords

obesity - wound healing - coronary artery bypass grafts surgery - coronary artery bypass graft

Note

Presented at the 45th annual meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) from February 13 to 16, 2016, Leipzig, Germany.


 

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