Coronary Revascularization Using Bilateral Internal Thoracic Arteries: Safe with Skeletonization?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Innovation

Background:

• Bilateral internal thoracic artery (BITA) grafting is associated with superior long-term survival in coronary artery bypass grafting (CABG).
• Despite evidence, BITA utilization remains low, particularly in the United States.
• Sternal wound complications are a concern with BITA grafting.

Purpose of the Study:

• To review the evidence supporting the benefits of BITA grafting.
• To examine the risks of sternal wound complications associated with BITA.
• To explore the protective role of the skeletonization technique in mitigating sternal wound infections in BITA recipients.

Main Methods:

• Literature review of studies on BITA grafting in CABG.
• Analysis of data on long-term survival outcomes.
• Evaluation of research on sternal wound infection rates and risk factors.
• Review of studies investigating the skeletonization technique for arterial harvest.

Main Results:

• BITA grafting demonstrates a significant long-term survival advantage compared to single arterial grafts.
• The use of BITA is associated with an increased risk of sternal wound complications.
• Harvesting the internal thoracic artery using the skeletonization technique appears to reduce the incidence of sternal wound infections.

Conclusions:

• BITA grafting is an underutilized technique with proven long-term survival benefits.
• Careful consideration of sternal wound complications is necessary when planning BITA grafting.
• The skeletonization technique may be a valuable strategy to enhance the safety of BITA grafting by reducing infection risk.