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Author Spotlight: Enhancing Coronary Artery Revascularization
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Coronary Revascularization Using Bilateral Internal Thoracic Arteries: Safe with Skeletonization?

Brody Wehman1, Bradley Taylor1

  • 1Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA.

Journal of Clinical & Experimental Cardiology
|April 25, 2014
PubMed
Summary

Bilateral internal thoracic artery (BITA) grafting offers long-term survival benefits in coronary artery bypass grafting but is underused. Skeletonization technique may reduce sternal wound infection risk with BITA use.

Keywords:
Bilateral internal thoracic arteryCoronary revascularizationSkeletonization sternal wound infection

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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.