First Indian survey conducted by Hyderabad based Sajja Heart Foundation has revealed that use of both right and left internal mammary arteries (RIMA & LIMA) during coronary artery bypass surgery increases the longevity of heart patients.
According to Dr. Lokeswar Rao Sajja, cardiac surgeon at Star Hospital and chairperson of Sajja Heart Foundation, only 4-5 per cent of patients all over the world have been operated using both mammary arteries during coronary bypass surgery. The main reason for this is technical difficulty during surgery, longer operative time and a slightly higher chance of getting sterna wound infection. “Currently, the standard technique for coronary artery bypass grafting surgery is using one (left) internal mammary artery (artery of the chest wall, LIMA) and leg vein grafts. Majority of coronary bypass surgeries are performed using this procedure. But our recent survey has found that using RIMA and LIMA from near the chest gives more longevity to the patient,” said Dr. Sajja.
Dr. Lokeswara Rao Sajja, conducted the first Indian survey on bilateral internal mammary artery grafting (BIMA) to determine the current use of BIMA grafting among cardiac surgeons in India and to identify the main concerns that limit the use of BIMA. The goal of the survey was to bring BIMA grafting to the mainstream and make BITA grafting a quality metric for CABG in younger patients.
The survey report observed that bilateral internal thoracic artery grafting during CABG is still low (5-10 per cent) among Indian cardiac surgeons and incidence of sterna infection following BITA harvesting is less than 3 per cent. BITA is advantageous in younger patients and about 30 per cent of patients undergoing CABG in India are under 59 years of age. In India, 41 per cent of patients undergoing CABG are diabetics. They, together with patients with mild LV dysfunction, will benefit from BITA.
Risk factors for BITA usage include smoking, people with chronic obstructive pulmonary disease (COPD), severely obese people with a BMI over 30, people with recent acute coronary syndrome or myocardial infarction, people with left ventricular ejection fraction of less than 30 per cent and those with poor coronary anatomy. Common concerns with BITA usage is the risk of deep sternal wound infection and increased operative time.