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A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement

Berroeta, Clarisse MD*; Benbara, Abdel MD*; Provenchère, Sophie MD*; Ajzenberg, Nadine MD, PhD†; Benessiano, Joelle PhD‡; Depoix, Jean-Pol MD*; Desmonts, Jean-Marie MD*; Iung, Bernard MD§; Philip, Ivan MD*

doi: 10.1213/01.ane.0000242514.49621.0c
Cardiovascular Anesthesia: Editorial

The superiority of the left internal mammary artery (LIMA) graft over autogenous saphenous vein as a bypass conduit in coronary artery bypass surgery has been well established. Early and late patency rates of bilateral internal mammary artery (BIMA) grafts exceed those of vein grafts, and patients who receive BIMA have improved long-term survival rates and more freedom from reoperations and other cardiac events. But because of other concerns, particularly the question of increased risk of postoperative bleeding, controversy still surrounds the perioperative period. In the present study we sought to determine whether BIMA grafting was an independent risk factor of postoperative bleeding and of blood product use in patients undergoing primary elective coronary artery revascularization. For this purpose, 33 consecutive patients scheduled for BIMA grafting were matched with 66 patients operated on by single LIMA grafting. Patients in the LIMA group had significantly less postoperative mediastinal drainage than those in the BIMA group (median: 722 vs 920 mL, P = 0.0001). Fifty-six patients received blood products (56% vs 51% in LIMA and BIMA groups, respectively; P = 0.67). In multivariate analysis, BIMA and operative duration were independent predictors of increased postoperative drainage. Nevertheless, in logistic regression, BIMA was not significantly associated with blood product use, unlike precardiopulmonary bypass hematocrit and duration of surgery (OR and 95% CI: 0.89 [0.80–0.96] P = 0.01; 1.009 [1.001–1.019] P = 0.04, for an increase of 1% in hematocrit and 1 min in duration of surgery, respectively). In conclusion, these data support the idea that BIMA graft slightly increases postoperative drainage but not transfusion requirement.

IMPLICATIONS: Bilateral internal mammary artery (BIMA) graft increases postoperative drainage. However, the clinical relevance of this risk remains low, since bleeding is moderate and does not lead to a higher transfusion requirement. Thus, the practice of BIMA should not be discouraged for fear of increased blood loss.

From the *Département Anesthésie-Réanimation; †Laboratoire d'Hématologie; ‡Centre d'Investigation Clinique; and §Service de Cardiologie, Hôpital Bichat-Claude Bernard Assistance Publique, Hôpitaux de Paris, France.

Accepted for publication August 3, 2006.

Address correspondence to: Dr C. Berroeta, Département d'Anesthésie, Hôpital Bichat-Claude Bernard 46, rue Henri Huchard, 75877 Paris Cedex 18, France. Address e-mail to Reprints will not be available from the author.

© 2006 International Anesthesia Research Society
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