### Abstract

BACKGROUND. The internal mammary artery is used as coronary artery graft conduit because of its superior patency. According to some authors, the bilateral IMA can increase perioperative morbidity. The aim of this study was to determine the risk factors increasing perioperative mortality and morbidity in the use of bilateral IMA. METHODS. We analyzed the data of 474 patients operated consecutively with the use of bilateral IMA between January 1987 and December 1995 at the Department of Cardiac Surgery of the Varese Hospital. The univariate analysis was done on 17 ordinal variables using a 'Fisher exact test' and on 4 continuous variables by 'pooled-variance t- test' to investigate risk factors for mortality, mediastinitis, superficial wound infection and aseptic dehiscence of the sternum; a p-value lower than 0.1 was used as cut-off point to introduce the variables into a stepwise multiple logistic regression analysis. RESULTS from the univariate analysis are: postoperative low-output syndrome (p = 0.01), LVEF (p = 0.02) and number of grafts (p = 0.04) are correlated to hospital mortality (1.5%); obesity (p <0.001) and peripheral arteriopathy (p = 0.009) are correlated to postoperative mediastinitis (5%); obesity (p <0.001), peripheral arteriopathy (p = 0.009), surgeon (p = 0.001), year of operation (p <0.001), reoperation for bleeding (p = 0.004) and length of extracorporeal circulation (p = 0.02) are correlated to superficial wound infection (7%); obesity (p = 0.002) and COPD (p = 0.05) are correlated to aseptic dehiscence of the sternum (2%). The multivariate analysis identified low LVEF as the only independent risk factor for hospital mortality (p = 0.03), whereas obesity (p = 0.01) and peripheral vasculopathy (p = 0.03) proved to be correlated to postoperative mediastinitis; obesity (p <0.001), year of the operation (p <0.001), low LVEF (p = 0.007) and reoperation for bleeding (p = 0.01) were correlated to superficial infection of the wound and obesity turned out to be the only risk factor for aseptic dehiscence of the sternum (p = 0.003). The infection of the wound did not increase mortality, but it did increase the mean post-operative length of hospital stay (6 days for patients free of any complications of the wound versus 29.7 days for patients with complications of the wound). CONCLUSIONS. In patients with bilateral mammary grafts, obesity is the main risk factor for complications of the wound and this event greatly increases the length of the patient's hospital stay. Consequently, we suggest that bilateral mammary artery grafts be used carefully in this subset of patients.

Original language | Italian |
---|---|

Pages (from-to) | 1230-1237 |

Number of pages | 8 |

Journal | Giornale Italiano di Cardiologia |

Volume | 28 |

Issue number | 11 |

Publication status | Published - Nov 1998 |

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### ASJC Scopus subject areas

- Cardiology and Cardiovascular Medicine

### Cite this

*Giornale Italiano di Cardiologia*,

*28*(11), 1230-1237.

**L'uso della arteria mammaria bilaterale nella rivascolarizzazione miocardica. Fattori di rischio emersi da un'analisi multivariata condotta su 474 pazienti.** / Tarelli, Giuseppe; Maugeri, Roberte; Pedretti, Roberte; Grossi, Claudio; Ornaghi, Diego; Sala, Andrea.

Research output: Contribution to journal › Article

*Giornale Italiano di Cardiologia*, vol. 28, no. 11, pp. 1230-1237.

}

TY - JOUR

T1 - L'uso della arteria mammaria bilaterale nella rivascolarizzazione miocardica. Fattori di rischio emersi da un'analisi multivariata condotta su 474 pazienti

AU - Tarelli, Giuseppe

AU - Maugeri, Roberte

AU - Pedretti, Roberte

AU - Grossi, Claudio

AU - Ornaghi, Diego

AU - Sala, Andrea

PY - 1998/11

Y1 - 1998/11

N2 - BACKGROUND. The internal mammary artery is used as coronary artery graft conduit because of its superior patency. According to some authors, the bilateral IMA can increase perioperative morbidity. The aim of this study was to determine the risk factors increasing perioperative mortality and morbidity in the use of bilateral IMA. METHODS. We analyzed the data of 474 patients operated consecutively with the use of bilateral IMA between January 1987 and December 1995 at the Department of Cardiac Surgery of the Varese Hospital. The univariate analysis was done on 17 ordinal variables using a 'Fisher exact test' and on 4 continuous variables by 'pooled-variance t- test' to investigate risk factors for mortality, mediastinitis, superficial wound infection and aseptic dehiscence of the sternum; a p-value lower than 0.1 was used as cut-off point to introduce the variables into a stepwise multiple logistic regression analysis. RESULTS from the univariate analysis are: postoperative low-output syndrome (p = 0.01), LVEF (p = 0.02) and number of grafts (p = 0.04) are correlated to hospital mortality (1.5%); obesity (p <0.001) and peripheral arteriopathy (p = 0.009) are correlated to postoperative mediastinitis (5%); obesity (p <0.001), peripheral arteriopathy (p = 0.009), surgeon (p = 0.001), year of operation (p <0.001), reoperation for bleeding (p = 0.004) and length of extracorporeal circulation (p = 0.02) are correlated to superficial wound infection (7%); obesity (p = 0.002) and COPD (p = 0.05) are correlated to aseptic dehiscence of the sternum (2%). The multivariate analysis identified low LVEF as the only independent risk factor for hospital mortality (p = 0.03), whereas obesity (p = 0.01) and peripheral vasculopathy (p = 0.03) proved to be correlated to postoperative mediastinitis; obesity (p <0.001), year of the operation (p <0.001), low LVEF (p = 0.007) and reoperation for bleeding (p = 0.01) were correlated to superficial infection of the wound and obesity turned out to be the only risk factor for aseptic dehiscence of the sternum (p = 0.003). The infection of the wound did not increase mortality, but it did increase the mean post-operative length of hospital stay (6 days for patients free of any complications of the wound versus 29.7 days for patients with complications of the wound). CONCLUSIONS. In patients with bilateral mammary grafts, obesity is the main risk factor for complications of the wound and this event greatly increases the length of the patient's hospital stay. Consequently, we suggest that bilateral mammary artery grafts be used carefully in this subset of patients.

AB - BACKGROUND. The internal mammary artery is used as coronary artery graft conduit because of its superior patency. According to some authors, the bilateral IMA can increase perioperative morbidity. The aim of this study was to determine the risk factors increasing perioperative mortality and morbidity in the use of bilateral IMA. METHODS. We analyzed the data of 474 patients operated consecutively with the use of bilateral IMA between January 1987 and December 1995 at the Department of Cardiac Surgery of the Varese Hospital. The univariate analysis was done on 17 ordinal variables using a 'Fisher exact test' and on 4 continuous variables by 'pooled-variance t- test' to investigate risk factors for mortality, mediastinitis, superficial wound infection and aseptic dehiscence of the sternum; a p-value lower than 0.1 was used as cut-off point to introduce the variables into a stepwise multiple logistic regression analysis. RESULTS from the univariate analysis are: postoperative low-output syndrome (p = 0.01), LVEF (p = 0.02) and number of grafts (p = 0.04) are correlated to hospital mortality (1.5%); obesity (p <0.001) and peripheral arteriopathy (p = 0.009) are correlated to postoperative mediastinitis (5%); obesity (p <0.001), peripheral arteriopathy (p = 0.009), surgeon (p = 0.001), year of operation (p <0.001), reoperation for bleeding (p = 0.004) and length of extracorporeal circulation (p = 0.02) are correlated to superficial wound infection (7%); obesity (p = 0.002) and COPD (p = 0.05) are correlated to aseptic dehiscence of the sternum (2%). The multivariate analysis identified low LVEF as the only independent risk factor for hospital mortality (p = 0.03), whereas obesity (p = 0.01) and peripheral vasculopathy (p = 0.03) proved to be correlated to postoperative mediastinitis; obesity (p <0.001), year of the operation (p <0.001), low LVEF (p = 0.007) and reoperation for bleeding (p = 0.01) were correlated to superficial infection of the wound and obesity turned out to be the only risk factor for aseptic dehiscence of the sternum (p = 0.003). The infection of the wound did not increase mortality, but it did increase the mean post-operative length of hospital stay (6 days for patients free of any complications of the wound versus 29.7 days for patients with complications of the wound). CONCLUSIONS. In patients with bilateral mammary grafts, obesity is the main risk factor for complications of the wound and this event greatly increases the length of the patient's hospital stay. Consequently, we suggest that bilateral mammary artery grafts be used carefully in this subset of patients.

KW - Coronary artery bypass graft

KW - Myocardial revascularization

UR - http://www.scopus.com/inward/record.url?scp=0031787808&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031787808&partnerID=8YFLogxK

M3 - Articolo

C2 - 9866800

AN - SCOPUS:0031787808

VL - 28

SP - 1230

EP - 1237

JO - Giornale Italiano di Cardiologia

JF - Giornale Italiano di Cardiologia

SN - 0046-5968

IS - 11

ER -