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Bilateral internal thoracic artery grafting
1Cleveland Clinic, Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, USA.
Insights
Bilateral internal thoracic artery (ITA) grafting improves survival rates in coronary bypass surgery. While complex, it offers superior long-term outcomes for suitable patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- The left internal mammary artery (LIMA) graft to the anterior descending coronary artery is a proven strategy for improving survival and reducing cardiac events.
- Superior short and long-term patency rates of the internal thoracic artery (ITA) contribute to its clinical benefits.
Purpose of the Study:
- To evaluate the advantages and disadvantages of using bilateral internal thoracic arteries (BITA) for coronary artery bypass grafting (CABG).
- To determine the optimal patient selection for BITA grafting based on predicted survival rates.
Main Methods:
- Review of multiple data sets supporting the use of BITA grafting.
- Analysis of clinical outcomes, including survival rates and adverse cardiac events.
- Assessment of surgical complexity and wound complication risks associated with BITA grafting.
Main Results:
- Bilateral ITA grafting is associated with improved patient survival rates.
- While BITA grafting increases surgical complexity and risk of wound complications, these are mitigated in contemporary practice.
- The benefits of BITA grafting, particularly improved survival, are now well-supported by multiple data sets.
Conclusions:
- Bilateral ITA grafting should be the preferred procedure for coronary bypass surgery in patients with a predicted survival rate exceeding ten years.
- The superior long-term patency and survival benefits of BITA grafting outweigh the manageable short-term disadvantages.
Abstract:
The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years.
