Coronary Artery Bypass Grafting (CABG) remains the gold standard for treating advanced coronary artery disease (CAD). Traditionally, surgeons rely on a single mammary artery (LIMA) or vein grafts. However, in recent years, Bilateral Internal Mammary Artery (BIMA) bypass surgery has become increasingly recognized for its superior long-term results.
Unlike conventional bypass, which often uses veins that may degenerate over time, BIMA grafting utilizes both the left and right internal mammary arteries. These arteries are naturally resistant to blockages, providing:
● Greater graft patency (lasting 15–20 years or more)
● Lower risk of repeat surgeries
● Improved long-term survival
For younger patients and those with diabetes, BIMA is often considered the most effective bypass surgery option for durable heart health.
Step-by-Step BIMA Bypass Procedure
1. Preoperative Assessment & Planning
Before surgery, patients undergo a comprehensive evaluation:
● Cardiac Imaging (angiography, CT, MRI) to assess blockages.
● Risk Profile Analysis (diabetes, obesity, age, comorbidities).
● Candidacy Evaluation to confirm whether BIMA is more suitable than traditional CABG.
This careful planning ensures the safest surgical approach with the best outcomes.
2. Surgical Technique Options
Conventional Sternotomy – The Standard Approach
Most BIMA procedures are performed through a median sternotomy (opening the breastbone). Both mammary arteries are harvested and attached to blocked coronary arteries to restore healthy blood flow.
Minimally Invasive & Robot-Assisted BIMA
In selected patients, surgeons may use minimally invasive or robot-assisted CABG.
● Small incisions or robotic arms allow precise grafting.
● Benefits: less trauma, reduced pain, faster recovery, and better cosmetic results.
● Popular among younger patients seeking a quicker return to normal life.
Skeletonized Harvesting – Safer Technique
Traditionally, concerns about wound complications limited BIMA’s use. Today, surgeons often
use skeletonized harvesting, where the artery is separated carefully while preserving the chest
wall blood supply.
● Reduces the risk of sternal wound infection
● Especially helpful for diabetic and obese patients
Off-Pump (Beating-Heart) BIMA Surgery
Unlike conventional CABG (which uses a heart-lung machine), off-pump BIMA is performed
while the heart is still beating.
● Reduces risks of stroke, kidney problems, and inflammation
● Safer for high-risk patients
Why Surgeons Recommend BIMA Bypass
● Superior Graft Patency: Internal mammary arteries resist blockages, often lasting
decades.
● Reduced Repeat Surgeries: Patients are far less likely to need reoperations.
● Proven Survival Advantage: Studies show improved long-term survival, especially the
preferred approach for patients of all ages, with no age restrictions.
● Ideal for Younger & Diabetic Patients: Offers durable protection against progressive
artery disease.
● Cost-Effective Long-Term: Fewer hospital readmissions and repeat procedures.
Frequently Asked Questions (FAQ)
Q1. What is the BIMA Bypass Procedure?
The BIMA Bypass Procedure (Bilateral Internal Mammary Artery Bypass) is an advanced type of CABG surgery that uses both the left and right internal mammary arteries instead of veins or a single artery. These arteries are highly resistant to blockages, providing better long-term blood flow, higher survival rates, and fewer repeat surgeries.
It is especially effective for younger patients, diabetics, and those with multiple blocked arteries, making it one of the most durable options for treating coronary artery disease.
Q2. How long does the BIMA bypass procedure take?
On average, 4–6 hours, depending on the number of grafts and surgical technique.
Q3. Are minimally invasive options available?
Yes. Robotic and minimally invasive CABG allow smaller incisions, faster recovery, and
minimal scarring. However, not all patients qualify.
Q4. What are the risks of BIMA bypass?
Possible risks include bleeding, infection, irregular heartbeat, or wound issues. With skeletonized harvesting, infection risks are much lower today.
Q5. Is BIMA bypass better than traditional CABG?
For many patients, yes. Using two mammary arteries instead of one provides better long-term
survival and fewer complications.
Q6. Who benefits most from BIMA bypass?
● Younger patients (under 7
● Diabetics are at a higher risk of artery disease progression
● Patients needing a long-term, durable solution
Preparing for Surgery & Recovery
Patients preparing for BIMA bypass surgery should:
● Quit smoking to improve healing.
● Maintain a heart-healthy diet and control blood sugar (especially for diabetics).
● Attend pre-surgery counseling to understand recovery expectations.
Recovery Timeline:
● Hospital stay: 5 – 7 days (longer if traditional sternotomy).
● Full recovery: 6 – 12 weeks, depending on health and type of procedure.
● Cardiac rehab: Exercise, diet, and lifestyle guidance to prevent recurrence.
Conclusion
The BIMA bypass procedure is more than just another heart surgery it’s a proven advancement in coronary care. By using both internal mammary arteries, surgeons provide patients with long-lasting protection against heart disease, better survival, and fewer repeat surgeries.
With minimally invasive options, skeletonized harvesting, and off-pump techniques, BIMA bypass has become safer and more widely available. For younger, diabetic, or high-risk patients, it is often the best surgical choice for long-term heart health.