Bilateral internal mammary artery grafting: are BIMA better?

The clinical and prognostic benefits of coronary artery bypass grafting (CABG) are well accepted for certain subgroups of patients with ischaemic heart disease, and as many as one million patients undergo this operation annually on a worldwide basis. Most CABG patients require grafting of the three main native coronary arteries; for the last 15 years the “standard” operation has achieved this using a single internal mammary artery (SIMA) and supplemental vein grafts performed with cardiopulmonary bypass. Although this procedure achieves excellent short and medium term outcome, and over 70% of patients are alive 12 years after surgery, the long term results are limited by progressive vein graft failure. Off pump coronary artery bypass (OPCAB) surgery and the increasing use of arterial conduits are now changing the nature of the standard CABG. This article reviews evidence for the routine use of bilateral internal mammary artery (BIMA) grafts in CABG patients.