Routine use of bilateral skeletonized internal thoracic artery grafting: long-term results

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Skeletonized harvesting of the internal thoracic artery (ITA) reduces sternal devascularization.
• This technique aims to decrease postoperative sternal complications in patients undergoing bilateral ITA grafting.

Purpose of the Study:

• To evaluate the outcomes of skeletonized bilateral ITA grafting.
• To identify risk factors for sternal infection and long-term mortality.

Main Methods:

• A consecutive series of 1515 patients underwent skeletonized bilateral ITA grafting between 1996 and 2001.
• Data on operative mortality, early morbidity, and late survival were collected.
• Statistical analyses included multiple regression for sternal infection and Cox regression for overall mortality.

Main Results:

• Operative mortality was 2.8%. Early sternal infection occurred in 1.6% of patients.
• Risk factors for sternal infection included COPD, repeat operations, and diabetes mellitus.
• 10-year survival rates varied by age, with patients >75 years having 52% survival.
• Increased mortality was associated with peripheral vascular disease, advanced age, repeat operations, congestive heart failure, and renal failure.
• Operations without cardiopulmonary bypass showed better postoperative survival.

Conclusions:

• Bilateral ITA grafting demonstrates low morbidity and favorable long-term outcomes.
• Skeletonized bilateral ITA grafting is appropriate for elderly patients and those with diabetes.
• This technique is not recommended for patients undergoing repeat operations or those with COPD.