Bilateral pedicled internal thoracic artery grafting

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Pedicled bilateral internal thoracic artery (BITA) grafting was historically avoided in high-risk patients due to mediastinitis concerns.
• Reassessment of BITA grafting with modern techniques is warranted given its established short and long-term efficacy.

Purpose of the Study:

• To evaluate the safety and efficacy of pedicled BITA grafting in a contemporary cohort, including high-risk individuals.
• To assess the incidence of mediastinitis and operative mortality associated with pedicled BITA grafting.

Main Methods:

• A retrospective study of 558 patients undergoing isolated coronary artery bypass grafting (CABG) using pedicled BITA grafts between 1989 and 1999.
• Surgical techniques focused on avoiding bone wax and excessive electrocautery, with implementation of pinpoint hemostasis in the later period.
• Analysis of patient risk factors, operative outcomes, and mediastinitis incidence.

Main Results:

• Despite an increase in high-risk patients (diabetes, renal failure) in the later study period, overall operative mortality was low (1.1%).
• Mediastinitis occurred in 1.3% of patients, with a significant decrease in the later period (0.4%).
• Obesity and arteriosclerosis obliterans were identified as independent risk factors for mediastinitis; diabetes, dialysis, and old age were not significant predictors.

Conclusions:

• Pedicled BITA grafting is a feasible and safe option for high-risk patients, including those with diabetes, renal failure, and advanced age.
• Meticulous surgical technique, including pinpoint hemostasis and strict aseptic protocols, is crucial for minimizing mediastinitis risk.
• BITA grafting should not be abandoned and requires a skilled surgical team for optimal conduit procurement and implantation.