The Use of Bilateral Internal Mammary Arteries for Coronary Revascularization in Patients with COPD: Is it a Good Idea?

Background: The use of bilateral internal mammary arteries (BIMA) is rarely used worldwide, especially in chronic obstructive pulmonary disease (COPD) patients. The literature discusses this topic controversially; therefore, we assessed the safety of the use of BIMA in patients suffering from COPD.

Methods: From cohorts of 8846 patients operated upon at our center for primary isolated multi-vessel coronary bypass operations from 2002 to 2012, we studied two propensity matched groups of patients with COPD who received either single internal mammary artery and saphenous vein grafts (SIMA group, 137 patients) or exclusively BIMA (BIMA group, 137 patients). Preoperative data were similar regarding age (63.59 ± 10.62 versus 65.55 ± 9.61 years; p = 0.10), body mass index (BMI) (28.6 ± 4.71 versus 28.42 ± 3.86 Kg/m²; p = 0.72), diabetes mellitus (32% versus 27%; p = 0.08), EuroSCORE (4.34 ± 2.23 versus 4.8 ± 2.52; p = 0.09) and ejection fraction (58.7 ± 13.08% versus 60.29 ± 14.13%; p = 0.32).

Results: No significant differences were noticed between the two groups regarding the number of peripheral anastomoses (3.07 ± 0.77 versus 3.06 ± 0.85; p = 0.90), total operation time (192.17 ± 43.06 versus 200.63 ± 39.24 minute.; p = 0.08), post operative stroke (0.7% versus 0%; p = 0.29), myocardial infarction (2.92% versus 3.6%; p = 0.81), reintubation (2.9% versus 4.4%; p = 0.66), reexploration (0.7% versus 2.2%; p = 0.32), deep sternal wound infection (2.9% versus 3.6%; p = 0.81) and 30 days mortality (2.2% versus 2.9%; p = 0.77). However, post operative blood loss (726.1 ± 468.35 versus 907 ± 890.58 ml; p = 0.03) was higher in BIMA group.

Conclusions: Despite the observed higher postoperative blood loss, the use of bilateral internal mammary arteries for coronary revascularisation seems to be safe and effective, even in patients with COPD.