Bilateral internal thoracic artery grafting: current state of the art

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease.
• Internal thoracic artery (ITA) grafts are associated with superior long-term patency compared to saphenous vein grafts.
• The use of bilateral internal thoracic arteries (BITA) for CABG remains a topic of ongoing research and debate.

Purpose of the Study:

• To review the current literature on bilateral internal thoracic artery grafting.
• To assess the benefits and risks associated with BITA grafting.
• To evaluate the impact of the skeletonization technique on surgical outcomes.

Main Methods:

• Comprehensive literature review of retrospective studies.
• Analysis of data comparing single versus bilateral internal thoracic artery grafting.
• Assessment of outcomes including mortality, cardiac events, and sternal wound complications.

Main Results:

• BITA grafting demonstrates a significant survival benefit over single ITA grafting, reducing all-cause death, cardiac-related death, and cardiac events.
• The survival advantage of BITA grafting is evident early post-operation, particularly in high-risk patients.
• Skeletonization technique decreases sternal wound complications, especially in diabetic patients.
• Both left and right ITA grafts show better patency than saphenous vein grafts to the left coronary territory.
• Right ITA graft patency to the right coronary artery is variable.

Conclusions:

• Bilateral internal thoracic artery grafting, particularly using the skeletonization technique, is recommended for revascularization of the left coronary territory.
• The skeletonization technique enhances the safety profile of BITA grafting.
• Further research may be warranted to optimize right ITA grafting outcomes.