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Ann Cardiothorac Surg. 2013 Jul;2(4):570-7. doi: 10.3978/j.issn.2225-319X.2013.06.03.

Bilateral internal mammary arteries: evidence and technical considerations.

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Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; The Baird Institute, Sydney, Australia; ; Sydney Medical School, The University of Sydney, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.


Bilateral internal mammary artery (BIMA) grafts are used for coronary revascularisation by only a minority of surgeons, despite a growing body of evidence suggesting improved survival when compared to use of only one internal mammary artery with additional saphenous vein grafts. Herein we review the evidence supporting revascularisation with BIMA and suggest reasons why the majority of surgeons use only one internal mammary artery. We discuss technical considerations, various graft combinations and the use of BIMA to facilitate anaortic off-pump coronary artery bypass (OPCAB).


BIMA; Internal mammary artery; OPCAB; coronary artery bypass graft

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