BIMAMMARY CORONARY BYPASS SURGERY IN COMORBID PATIENTS

Highlights Given the current trend in coronary surgery towards an increase in the number of bimammary coronary bypass surgeries and conflicting research findings on in-hospital and long-term outcomes, the choice of the optimal method of revascularization in patients with high perioperative risk and comorbid condition remains relevant. A number of studies have demonstrated the advantage of coronary artery bypass grafting using two internal thoracic arteries, but the only randomized multicenter prospective study did not reveal the advantages of this technique compared to the traditional one in patients with coronary artery disease and multivessel coronary artery disease, which necessitates further research to determine the most effective and safe method of surgical myocardial revascularization, including in comorbid patients. Abstract This article presents a literature review on the use of bimammary coronary bypass surgery in comorbid patients with diabetes mellitus, obesity, chronic kidney disease and chronic heart failure with a low left ventricular ejection fraction, as well as in patients with certain demographic characteristics: female, elderly and senile age; including an analysis of current data in databases “PubMed” and “Google Scholar” published in 2017–2024. Various techniques for performing coronary bypass surgery using two internal thoracic arteries are presented, the advantages and disadvantages of using bimammary revascularization in comorbid patients are described. Currently, it is not possible to determine the optimal technique for surgical myocardial revascularization, and therefore the issue of bimammary myocardial revascularization in patients with high risk of complications, taking into account all the advantages and disadvantages of this technique, remains unresolved.