Short and long-term results of using bilateralinternal mammary artery in elderly patients

Authors: Galimov N.M., Martirosyan A.K., Zhbanov I.V., Uryuzhnikov V.V., Kiladze I.Z., Revishvili G.A., Shabalkin B.V., Perevertov V.A., Aleksandrova E.N.

Company: Petrovsky Russian Research Center of Surgery, Abrikosovskiy pereulok, 2, Moscow, 119991, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


For citation: Galimov N.M., Martirosyan A.K., Zhbanov I.V., Uryuzhnikov V.V., Kiladze I.Z., Revishvili G.A., Shabalkin B.V., Perevertov V.A., Aleksandrova E.N. Short and long-term results of using bilateral internal mammary artery in elderly patients. Creative Cardiology. 2019; 13 (4): 328–38 (in Russ.). DOI: 10.24022/1997-3187-2019-13- 4-328-338

Received / Accepted:  02.12.2019/15.12.2019

Keywords: old age bilateral internal mammary artery immediate and long-term results

Subscribe 🔒



Objective. To study the short and long-term results of the coronary artery bypass grafting using two internal thoracic arteries in elderly patients and to determine the prospects of this operation in this age group.

Material and methods. A retro- and prospective analysis of the results of surgical treatment of 205 patients older than 70 years, who underwent isolated coronary artery bypass grafting, was carried out. Two groups were formed: in group 1 – two internal mammary arteries were used, and in group 2 – one internal mammary artery. When analyzing the results of the postoperative period (mean follow-up time 66±26 months), the duration of the patient's stay in cardiac intensive care and in hospital, survival after surgery, freedom from cardiac events (myocardial infarction, recurrence of angina, fatal rhythm disorders, repeated myocardial revascularization) were studied.

Results. We noted a significant increase in surgery time in the group where both internal mammary arteries were used for myocardial revascularization (259.7±53.8 minutes vs. 235.4±45.3 minutes, p=0.001). The duration of stay in the cardiac intensive care unit and the frequency of perioperative complications did not differ significantly between the groups (p>0.05). The cumulative survival analysis also revealed no statistically significant differences after coronary bypass surgery using two and one internal thoracic artery over a 7-year follow-up period (p=0.112). But the freedom from cardiac complications was significantly higher in the group where both internal thoracic arteries were used (82.9% vs. 68.2%, p=0.016).

Conclusion. The short-term postoperative results of coronary bypass surgery using two internal thoracic arteries in elderly patients do not differ from those of traditional coronary bypass surgery with one internal thoracic artery. Bimammary coronary bypass surgery in patients of this age group is not associated with an increase in the frequency of perioperative complications and with sufficient experience can be performed at a high level of safety.


  1. Global atlas on cardiovascular disease prevention and control. Ed. by Mendis S., Pusra P., Norrving B. Zheneva: WHO; 2013: 2–57 (in Russ.)
  2. Nicolini F., Agostinelli A., Vezzani A., Manca T., Benassi F., Molardi A. et al. The evolution of cardiovascular surgery in elderly patient: a review or current options and outcomes. Biomed Res. Int. 2014; 2014: 736298. DOI: 10.1155/2014/736298
  3. Al-Sabti H., Al-Kindi A., Al-Rasadi K., Banerjee Y. Saphenous vein graft vs radial artery graft searching for the best second coronary artery bypass graft. J. Saudi Heart Ass. 2013; 25: 247–54. DOI: 10.1016/j.jsha.2013.06.001
  4. Song S.-W., Sul S.-Y., Lee H.-J., Yoo K.-J. Comparison of the radial artery and saphenous vein as composite grafts in off-pump coronary artery bypass grafting in elderly patients: a randomized controlled trial. Korean Circ. J. 2012; 42: 107–12. DOI: 10.4070/kcj.2012.42.2.107
  5. Sheremet'eva G.F., Ivanova A.G., Zhbanov I.V. Dynamics of morphological changes of autovenous graft after coronary artery bypass grafting. Russian Journal of Thoracic and Cardiovascular Surgery. 2001; 2: 34–9 (in Russ.).
  6. Gaudino M., Benedetto U., Fremes S., Biondi- Zoccai G., Sedrakyan A., Puskas J.D. et al. Radialartery or saphenous-vein grafts in coronary-artery bypass surgery. N. Engl. J. Med. 2018; 378 (22): 2069–77. DOI: 10.1056/NEJMoa1716026
  7. Tatoulis J. Total arterial coronary revascularization – patient selection, stenoses, conduits, targets. Ann. Cardiothorac. Surg. 2013; 2: 499–506. DOI: 10.3978/j.issn.2225-319X.2013.07.02
  8. Buxton B.F., Galvin S.D. The history of arterial revascularization: from Kolesov to Tector and beyond. Ann. Cardiothorac. Surg. 2013; 2: 419–26. DOI: 10.3978/j.issn.2225-319X.2013.07.24
  9. Buxton B.F., Hayward P.A.. The art of arterial revascularization – total arterial revascularization in patients with triple vessel coronary artery disease. Ann. Cardiothorac. Surg. 2013; 2: 543–51. DOI: 10.3978 / j.issn.2225-319X.2013.07.14
  10. Loop F.D., Lytle B.W., Cosgrove D.M., Stewart M.D., Goormastic M., Williams G.W. et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. New Engl. J. Med. 1986; 314: 1–6. DOI: 10.1056/NEJM198601023140101
  11. Gaudino M., Alexander J.H., Bakaeen F.G., Ballman K., Barili F., Calafiore A.M. et al. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial – rationale and study protocol. Eur. J. Cardiothorac. Surg. 2017; 52 (6): 1031–40. DOI: 10.1093/ejcts/ezx358
  12. Lytle B.W. Bilateral internal thoracic artery grafting. Ann. Cardiothorac. Surg. 2013; 2: 485–92. DOI: 10.3978/j.issn.2225-319X.2013.07.04
  13. Buxton B.F., Tatoulis J., Fuller J.A. The right internal thoracic artery: the forgotten conduit – 5,766 patients and 991 angiograms. Ann. Cardiothorac. Surg. 2011; 92: 9–15. DOI: 10.1016/j.athoracsur.2011.03.099
  14. Zhbanov I.V., Martirosyan A.K., Uryuzhnikov V.V., Kiladze I.Z. Galimov N.M., Revishvili G.A. et al. Multiple coronary artery bypass surgery using two internal thoracic arteries. Clinical and Experimental Surgery Petrovsky Journal. 2018; 6; 4 (22): 66–74 (in Russ.). DOI: 10.24411/2308-1198-2018-14010
  15. Zhbanov I.V., Shabalkin B.V. Long-term results of redo coronary artery bypass grafting. Russian Journal of Thoracic and Cardiovascular Surgery. 2000; 1: 35–7 (in Russ.).
  16. Ruka E., Dagenais F., Mohammadi S., Chauvette V., Poirier P., Voisine P. Bilateral mammary artery grafting increases postoperative mediastinitis without survival benefit in obese patients. Eur. J. Cardiothorac. Surg. 2016; 50 (6): 1188–95. DOI: 10.1093/ejcts/ezw164
  17. Taggart D.P. Current status of arterial grafts for coronary artery bypass grafting. Ann. Cardiothorac. Surg. 2013; 2: 427–30. DOI: 10.3978/j.issn.2225-319X.2013.07.21
  18. Sidorov R.V., Eroshenko O.L., Pospelov D.Yu. Experience in coronary artery bypass grafting using both internal thoracic arteries in patients with coronary heart disease. Bulletin of Pirogov National Medical and Surgical Center. 2011; 6 (2): 33–6 (in Russ.).
  19. Buxton B.F., Shi W.Y., Tatoulis J., Fuller J.A., Rosalion A., Hayward P.A. Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival. J. Thorac. Cardiovasc. Surg. 2014; 148 (4): 1238–44. DOI: 10.1016/j.jtcvs.2014.06.056
  20. Itagaki S., Cavallaro P., Adams D.H., Chikwe J. Bilateral internal mammary artery grafts, mortality and morbidity: an analysis of 15 263 coronary bypass operations. Heart. 2013; 99 (12): 849–53. DOI: 10.1136/heartjnl-2013-303672
  21. Buxton B.F., Hayward P.A.R., Newcomb A.E., Moten S., Seevanayagam S., Gordon I. Choice of conduits for coronary artery bypass grafting: craft or science? Eur. J. Cardiothorac. Surg. 2009; 35: 658–700. DOI: 10.1016/j.ejcts.2008.10.058
  22. Gaudino M., Lorusso R., Rahouma M., Abouarab A., Tam D.Y., Spadaccio C. et al. Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: a network meta-analysis of clinical outcomes. J. Am. Heart Assoc. 2019; 8 (2): e010839. DOI: 10.1161/JAHA.118.010839
  23. Mohammadi S., Dagenais F., Doyle D., Mathieu P., Baillot R., Charbonneau E. et al. Age cut-off for the loss of benefit from bilateral internal thoracic artery grafting. Eur. J. Cardiothorac. Surg. 2008; 33: 977–82. DOI: 10.1016/j.ejcts.2008.03.026
  24. Benedetto U., Amrani M., Raja S.G. Guidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups. J. Thorac. Cardiovasc. Surg. 2014; 148: 2706–11. DOI: 10.1016 / j.ejcts.2008.03.026
  25. Kurlansky P.A., Traad E.A., Dorman M.J., Galbut D.L., Ebra G. Bilateral versus single internal mammary artery grafting in the elderly: long-term survival benefit. Ann. Thorac. Surg. 2015; 100: 1374–81; discussion 1381–82. DOI: 10.1016/j.athoracsur.2015.04.019
  26. Medalion B., Mohr R., Frid O., Uretzky G., Nesher N. Paz Y. et al. Should bilateral internal thoracic artery grafting be used in elderly patients undergoing coronary artery bypass grafting? Circulation. 2013; 127: 2186–93. DOI: 10.1161/CIRCULATIONAHA.112.001330

About Authors

  • Nariman M. Galimov, Postgraduate; ORCID
  • Armen K. Martirosyan, Cardiovascular Surgeon; ORCID
  • Igor' V. Zhbanov, Dr. Med. Sc., Professor, Head of Department; ORCID
  • Vadim V. Uryuzhnikov, Cand. Med. Sc., Senior Researcher; ORCID
  • Irakli Z. Kiladze, Cand. Med. Sc., Senior Researcher; ORCID
  • Georgiy A. Revishvili, Postgraduate; ORCID
  • Boris V. Shabalkin, Dr. Med. Sc., Professor; ORCID
  • Vadim A. Perevertov, Cand. Med. Sc., Cardiologist; ORCID
  • Elena N. Aleksandrova, Cardiologist; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery