Thorac Cardiovasc Surg 2016; 64 - OP43
DOI: 10.1055/s-0036-1571502

Use of Bilateral Internal Mammary Arteries in Obese Patients

Y. Hegazy 1, 2, N. Keshk 1, S. Bauer 1, W. Hassanein 2, F. Kojqiqi 1, K. Bauer 1, R. Sodian 1, J. Ennker 3
  • 1Mediclin Herzzentrum, Lahr, Germany
  • 2Alexandria Faculty of Medicine, Cardio-Thoracic Surgery, Alexandria, Egypt
  • 3Helios Klinikum, Siegburg, Germany

Background: Obesity is one of the limiting factors for the use of bilateral internal mammary arteries (BIMA). Therefore, we assessed the safety of their use in different degrees of obesity.

Patients and methods: From cohorts of patients operated upon at Heart Institute Lahr/Baden for primary isolated multi-vessel coronary bypass operations, we studied two groups of obese patients using a one-to-one propensity matching. The first group received single internal mammary artery and saphenous vein grafts (SIMA group, 526 patients), the second group received exclusively BIMA (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 ≥ 35kg/m2).

Preoperative data were similar regarding age (62.78 ± 9.96 versus 62.98 ± 9.66 years; p = 0.734), female gender (17.5% versus 18.6%; p = 0.631), BMI (29.16 ± 3.24 kg/m2 versus 29.12 ± 3.06 kg/m2; p = 0.905), diabetes mellitus (26.3% versus 27.2%; p = 0.74), EuroSCORE (3.21 ± 2.23 versus 3.18 ± 2.41; p = 0.968), COPD (16% versus 16%; p = 1) and ejection fraction (60.57 ± 12.31% versus 60.90 ± 12.66%; p = 0.675).

Results: No significant differences were noticed between the two groups regarding the number of peripheral anastomoses (3.09 ± 0.84 versus 3.12 ± 0.83; p = 0.633), total operation time (195.02 ± 49.21 versus 201.87 ± 43.57 minute.; p = 0.08), post operative stroke (1% versus 0.4%; p = 0.26), myocardial infarction (1.7% versus 1.7%; p = 1), reintubation (1.9% versus 2.5%; p = 0.53), reexploration (1.3% versus 2.1%; p = 0.34), deep sternal wound infection (2.1% versus 2.9%; p = 0.43) and 30-day mortality (0.8% versus 1.1%; p = 0.53). However, post operative blood loss (742.56 ± 625.42 versus 866.01 ± 677.50 ml; p< 0.001) and the incidence of pneumothorax (1% versus 2.7%; p = 0.01) were higher in BIMA group, whereas the incidence of postoperative delirium was higher in SIMA group (5.3% versus 2.1%; p = 0.006).

Conclusions: Obese patients can benefit from coronary artery revascularization with BIMA, however, postoperative blood loss and the incidence of pneumothorax can be higher using this technique.