OBJECTIVE To compare postoperative and long-term results (angina,
myocardial and cerebrovascular events and coronary re-intervention)
using single versus bilateral internal mammary arteries (SIMA vs. BIMA)
in the setting of off-pump revascularisation (OPCAB) within a
single-surgeon practice. METHODS Retrospective analysis of all isolated
OPCAB performed in our institution by a single surgeon in the last 12
years.Two groups were analysed: SIMA (n = 681) and BIMA (n = 342). A
propensity score matching was performed to compare the groups, reducing
the sample to 684 patients.Follow-up (mean 6.5 ± 3.5 years) was done by
telephone interviews or clinical visits, registering also late mortality
and coronary re-intervention. Outcomes were compared to literature.
RESULTS Demographic characteristics differed between groups, with BIMA
offered predominantly to non-diabetic younger males (mean 59.4 years)
with less comorbidity. In-hospital mortality was 2% for the SIMA group
and 1% for BIMA (p = 0.18). Long-term mortality was also higher for the
SIMA group (2% vs. 1% at 1 year, p = 0.22 and 16% vs. 5% at 5 years,
p < 0.001). Sternal wound infection was similar in both groups
(2-3%). Long-term follow-up revealed good freedom from angina (94%)
with low rates of neurological and myocardial events (3%) or need for
repeated revascularisation (3%) in both groups. CONCLUSION BIMA offers
long-term survival benefit with similar postoperative complications.
Rates of deep sternal wound infection were comparable between the two
groups.Excellent outcomes can be achieved with OPCAB BIMA in real world
practice with adequate patient selection.