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Bilateral internal thoracic artery grafting.

Bruce W Lytle¹

¹Cleveland Clinic, Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, USA.

Annals of Cardiothoracic Surgery

|August 27, 2013

Summary

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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.

Keywords:

Coronary bypass surgery bilateral internal thoracic artery grafting

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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.