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Related Experiment Video

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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

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Conduits for coronary bypass: internal thoracic artery.

Hendrick B Barner¹

¹Division of Cardiothoracic Surgery, St. Louis University Hospital, USA.

The Korean Journal of Thoracic and Cardiovascular Surgery

|January 1, 2013

Summary

The internal thoracic artery (ITA) has evolved as a superior graft for coronary artery bypass surgery. Despite initial skepticism, its long-term patency and survival benefits have led to wider adoption over saphenous vein grafts.

Keywords:

Coronary artery disease Coronary grafting Mammary arteries

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Area of Science:

Cardiovascular Surgery
Vascular Grafting
Coronary Artery Bypass Grafting (CABG)

Background:

The internal thoracic artery (ITA) was initially viewed with skepticism as a graft for coronary artery bypass surgery.
Early concerns included technical difficulties in harvesting, graft size, spasticity, and questionable flow capacity.

Purpose of the Study:

To present the authors' experience and views on the use of the internal thoracic artery (ITA) since 1966.
To trace the evolution of ITA acceptance as a coronary artery bypass conduit.

Main Methods:

Historical review of the authors' experience with ITA grafts.
Analysis of angiographic data and survival benefits over time.
Observation of surgeon adoption trends and graft utilization rates.

Main Results:

Angiographic data after a decade demonstrated superior patency rates for ITA grafts compared to saphenous vein grafts.
Reported survival benefits further supported the efficacy of ITA grafting.
Despite evidence, widespread adoption was slow, taking decades to become a preferred conduit.

Conclusions:

The internal thoracic artery (ITA) is a highly effective conduit for coronary artery bypass surgery, offering superior long-term patency.
Overcoming initial surgeon skepticism required substantial evidence of improved outcomes and survival.
Current trends show expanding use of ITA, including bilateral applications, in coronary artery bypass procedures.