OBJECTIVE: Data on bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) on diabetics were analyzed; This is the only meta-analysis, the last 7 years.
METHODS: Medline through PubMed/EMBASE/CINHAL and the Cochrane Central Register of Controlled Trials; 179 articles were studied; 19 studies deemed suitable and were included in the analysis.
RESULTS: The mortality was 2.41% for BIMA versus 1.71% for SIMA (odds ratio [OR] =  0.95; 95% confidence interval [CI]: 0.74-1.22). Postoperative reopening for bleeding was higher at 3.75% for BIMA versus 2.91% for SIMA (OR =  1.49; 95% CI: 1.15-1.93). The incidence of MI was 0.87% for BIMA versus 0.83% for SIMA (OR =  0.73; 95% CI: 0.37-1.44). Deep sternal wound infection was 3.02% for BIMA and 1.95% for SIMA (OR =  1.57; 95% CI: 1.26-1.95). When skeletonized, the incidence of DSWI was 2.5% for BIMA versus 2.41% for SIMA. There was a significant difference at 5-year survival favoring the BIMA, 85.15% BIMA versus 80.77% SIMA (OR =  1.79; 95% CI: 1.60-2.01). The 10-year overall survival was 74.04% BIMA versus 61.57% SIMA (OR =  1.79; 95% CI: 1.61-1.98). The 15-year survival was 47.08% for BIMA versus 37.06% for SIMA (OR =  1.69; 95% CI: 1.52-1.88).
CONCLUSIONS: Postoperative bleeding was higher in BIMA group. Bilateral internal mammary artery in diabetic patients should be carried out in a skeletonize fashion, to reduce DSWI. There is a survival benefit of using BIMA in diabetics within 5 years of surgery; it remains significant up to 15 years.

The meta-analysis aims to evaluate and compare the sternal wound infections following internal mammary artery grafts for a coronary bypass. Examinations comparing bilateral internal mammary artery to single internal mammary artery for coronary artery bypass grafting were among the meta-analyses from various languages that met the inclusion criteria. Using dichotomous random- or fixed-effect models, the results of these investigations were examined, and the Odd Ratio (OR) with 95% confidence intervals (CIs) was computed. A total of 31 examinations from 2001 to 2023 were recruited for the current analysis including 181 503 personals with coronary artery bypass grafting. Bilateral internal mammary artery had significantly higher sternal wound infection (OR, 1.51; 95% CI, 1.37-1.68, p < 0.001), superficial sternal wound infection (OR, 1.72; 95% CI, 1.16-2.56, p = 0.007), deep sternal wound infection (OR, 1.62; 95% CI, 1.41-1.86, p < 0.001), sternal wound infection in diabetics (OR, 1.48; 95% CI, 1.16-1.90, p = 0.002), sternal wound infection in elderly (OR, 1.38; 95% CI, 1.22-1.57, p < 0.001), sternal wound infection in pedicled preparation (OR, 1.70; 95% CI, 1.30-2.23, p < 0.001) and sternal wound infection in skeletonized preparation (OR, 1.40; 95% CI, 1.09-1.81, p = 0.009) compared to single internal mammary artery in personals with coronary artery bypass grafting. Bilateral internal mammary artery grafting is linked to a higher risk of impaired wound healing, particularly in diabetic individuals, elderly, pedicled preparation, and skeletonized preparation. Nevertheless, caution should be exercised while interacting with its values since examinations were performed by different surgeons with different skills on different types of personals.

To evaluate safety of coronary artery bypass surgery using bilateral internal mammary artery and effectiveness of this procedure in long-term postoperative period.
The study involved 129 patients who underwent CABG for the period 2006-2007. There were 2 groups of patients depending on surgical strategy: group 1 (n=61) - double IMA harvesting, group 2 (n=68) - CABG using single IMA. Short-term results were compared using standard statistical methods. Long-term survival was compared using Kaplan-Meyer method.
Revascularization index was 3.014±0.76 in the 1st group and 3.1±0.73 in the 2nd group (p>0.05). In-hospital mortality was 0% and 1.47%, respectively (p> 0.05). A 10-year survival was 95.1% and 91.2%, respectively (p>0.05). Freedom from cardiac events (mortality, myocardial infarction, recurrent angina pectoris) was significantly different (95% vs. 81%, p<0.05).
Significantly lower rate of adverse cardiac events in long-term postoperative period in comparison with conventional CABG clearly demonstrates high quality of life after coronary artery bypass surgery using bilateral internal mammary artery for a long time. Therefore, this procedure is preferred in patients with coronary artery disease.
Результатами многолетнего совершенствования методов хирургического лечения больных ишемической болезнью сердца во многих ведущих кардиохирургических клиниках являются минимальная госпитальная летальность и низкий уровень риска коронарного шунтирования. Однако выбор наиболее эффективной операции остается предметом дискуссии. Цель исследования - оценить безопасность операции коронарного шунтирования с использованием двух внутренних грудных артерий и ее эффективность в отдаленном послеоперационном периоде.
В работу включили 129 пациентов, которым в отделении хирургии ишемической болезни сердца с 2006 по 2007 г. выполнили аортокоронарное шунтирование. Сформировали две группы больных: в 1-й группе (n=61) для реваскуляризации миокарда применили две внутренние грудные артерии, во 2-й группе (n=68) - только одну. Краткосрочные результаты сравнивали с использованием стандартных статистических методов, долгосрочную выживаемость - с использованием оценок Каплана-Мейера.
Индекс реваскуляризации в 1-й группе - 3,014±0,76, во 2-й 3,1±0,73 (р>0,05). Госпитальная летальность во 2-й группе составила 1,47%, в 1-й группе смертельных исходов не было (р>0,05). Анализ отдаленных результатов (до 10 лет после операции) показал статистически недостоверные (р<0,05) различия в выживаемости - 95,1% в 1-й группе против 91,2% во 2-й, в то же время неблагоприятные кардиальные события (летальность, инфаркт миокарда, рецидив стенокардии) отсутствовали в 1-й группе в 95%, во 2-й - в 81% (различия достоверны, р<0,05).
Достоверно меньшая вероятность неблагоприятных кардиальных событий в отдаленном послеоперационном периоде по сравнению с традиционным коронарным шунтированием наглядно демонстрирует стабильно высокое качество жизни после бимаммарного коронарного шунтирования в течение долгого времени. Полученные результаты дают нам все основания считать бимаммарное коронарное шунтирование операцией выбора у большинства больных ишемической болезнью сердца.

This analysis compared short-term mortality, sternal wound infection (SWI), and long-term survival outcomes in diabetic patients who underwent coronary artery bypass grafting (CABG) with bilateral (BIMA) vs. single (SIMA) internal mammary artery, as well as in diabetic vs. non-diabetic patients undergoing BIMA grafting.Methods and Results:Nineteen studies were included in the study, covering 21,143 different patients. Of these patients, 6,464 underwent CABG with BIMA, 10,264 underwent CAGB with SIMA, 11,584 had diabetes, and 6,717 did not. Compared with SIMA, BIMA had a significantly lower risk of in-hospital mortality (odds ratio [OR] 0.73, P=0.02), but a significantly higher risk of SWI (OR 1.30, P=0.04). However, compared with non-diabetic patients who underwent CABG with BIMA, diabetic patients with BIMA grafting did not have significantly higher risks of either mortality (OR 1.22, P=0.53) or SWI (OR 1.10, P=0.72). No significant differences were detected with different harvesting techniques. Longer term, BIMA was associated with a significantly higher rate of survival than SIMA (hazard ratio [HR] 0.76, P<0.001).
Results from the 2 types of comparisons indicate that BIMA is a preferable option for diabetic patients, even though it has a higher risk of infection. CABG with BIMA is also associated with a long-term survival benefit.

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