[Fifteen-year results of bilateral and unilateral internal mammary artery grafting].

Autor:	Martirosyan AK; Petrovsky National Research Center of Surgery, Moscow, Russia., Zhbanov IV; Petrovsky National Research Center of Surgery, Moscow, Russia., Kiladze IZ; Petrovsky National Research Center of Surgery, Moscow, Russia., Perevertov VA; Petrovsky National Research Center of Surgery, Moscow, Russia., Aleksandrova EN; Petrovsky National Research Center of Surgery, Moscow, Russia., Nosachev ZS; Petrovsky National Research Center of Surgery, Moscow, Russia., Akhmetov AZ; Petrovsky National Research Center of Surgery, Moscow, Russia., Shabalkin BV; Petrovsky National Research Center of Surgery, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Khirurgiia [Khirurgiia (Mosk)] 2024 (5), pp. 51-57.
DOI:	10.17116/hirurgia202405151
Abstrakt:	Objective: To evaluate the clinical effectiveness of bilateral internal mammary artery grafting over long-term (15 years) postoperative period. Material and Methods: There were 276 patients divided into two groups: 135 patients (group A) underwent bilateral internal mammary artery grafting and 141 patients (group B) underwent unilateral internal mammary artery grafting together with venous bypass grafts. On-pump surgeries and cardioplegia, parallel CPB and on-pump procedures were performed in equal proportions. Mean age of patients was 57.3±7.6 years. Diabetes mellitus was detected in 21 (15.5%) and 24 (19.1%) patients, respectively ( p >0.05). Mean LV ejection fraction was 55.4±9.9%, revascularization index - 3.1±0.8 and 3.0±0.7, respectively. In the 1 st group, 43 patients underwent bilateral internal mammary artery grafting alone. Autovenous grafts were additionally used in other 84 patients. Results: Ten-year survival exceeded 90% in both groups. Freedom from adverse cardiac events after 15 years was significantly higher in group A (77.3% vs. 59.3%, p =0.018). In group A, 16 patients died throughout this period due to cancer (50%), myocardial infarction (12.5%), stroke (18.8%) and complications of diabetes mellitus (6.3%). In group B, 22 patients died mainly from cardiac causes (myocardial infarction - 40.9%, cancer - 27.3%). Conclusion: Bilateral internal mammary artery grafting has obvious advantages over traditional coronary artery bypass grafting. If we take into account higher proportion of cardiac causes in structure of mortality in group B, we can talk about positive impact of bilateral internal mammary artery grafting not only on the quality of life, but also on life expectancy in long-term postoperative period.
Databáze:	MEDLINE
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