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Bilateral internal thoracic arteries: what is the State of the ART?

Bobby Yanagawa1, Subodh Verma, John D Puskas

  • 1aDivision of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, CanadabDepartment of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Current Opinion in Cardiology
|August 11, 2017
PubMed

Insights

Bilateral internal thoracic artery (BITA) grafting offers protective benefits in coronary artery bypass grafting, despite potential sternal complications. Wider adoption is recommended, pending long-term trial results.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Surgical Innovation

Background:

  • Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease.
  • The use of bilateral internal thoracic artery (BITA) grafts in CABG has been debated due to potential benefits and risks.
  • Evidence synthesis is crucial for optimizing surgical strategies in CABG.

Purpose of the Study:

  • To review the current evidence on the use of BITA in CABG.
  • To evaluate the efficacy, safety, and outcomes associated with BITA grafting.
  • To inform clinical practice and future research directions in arterial revascularization.

Main Methods:

  • Comprehensive literature review of observational studies and clinical trials.
  • Analysis of graft patency, clinical outcomes, and complications associated with BITA use.
  • Examination of data from the Arterial Revascularization Trial (ART).

Main Results:

  • Observational data predominantly support BITA use, showing protective effects on graft patency and clinical outcomes.
  • No significant difference in outcomes based on the specific configuration of BITA grafting.
  • Increased risk of sternal complications is a concern, but can be mitigated with sternal-sparing techniques.
  • Interim ART results at 5 years did not demonstrate a clinical benefit for BITA over single internal thoracic artery, with final results pending.

Conclusions:

  • Current literature supports the use of BITA for surgical revascularization in CABG.
  • Anticipation of long-term results from the Arterial Revascularization Trial is high.
  • A consensus suggests increasing the proportion of CABG procedures utilizing BITA grafts.
Abstract

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