Bilateral internal mammary arteries: evidence and technical considerations

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for coronary revascularization.
• Internal mammary artery (IMA) grafts are associated with superior long-term patency rates compared to saphenous vein grafts.
• Bilateral internal mammary artery (BIMA) grafting offers potential survival benefits over single IMA or vein grafts, yet its adoption is limited.

Purpose of the Study:

• To review the evidence supporting the use of BIMA grafts for coronary revascularization.
• To explore the reasons behind the suboptimal utilization of BIMA grafts by surgeons.
• To discuss technical aspects, graft strategies, and the role of BIMA in anaortic off-pump coronary artery bypass (OPCAB).

Main Methods:

• Literature review of studies comparing BIMA grafts with single IMA or vein grafts.
• Analysis of factors influencing surgeon choice regarding graft selection.
• Discussion of surgical techniques and graft configurations for BIMA utilization.

Main Results:

• Evidence suggests improved survival rates with BIMA grafting compared to single IMA or vein grafts.
• Several factors contribute to the limited use of BIMA, including perceived technical complexity and concerns about sternal wound complications.
• BIMA grafts can be effectively used in various combinations and facilitate OPCAB procedures.

Conclusions:

• BIMA grafting represents a valuable option for coronary revascularization, offering superior long-term outcomes.
• Addressing surgeon concerns through education and standardized techniques may increase BIMA adoption.
• Further research and surgeon education are crucial to optimize the use of BIMA for improved patient survival.