The Skeleton in the Closet: Harvesting a Skeletonized IMA

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Current data indicate a survival advantage for patients undergoing coronary bypass operations using more than one arterial graft.
• The Society of Thoracic Surgeons provides guidelines for optimal arterial graft utilization in coronary artery bypass grafting (CABG).

Discussion:

• Internal mammary arteries (IMAs) are recommended for bypassing the left anterior descending (LAD) artery when indicated.
• Consideration of a second arterial graft, such as the right IMA or radial artery (RA), as an adjunct to the left IMA (LIMA) is advised for suitable patients.
• Bilateral IMAs (BIMAs) may be considered in patients without excessive sternal complication risk.

Key Insights:

• To mitigate sternal infection risk with BIMAs, strategies include skeletonized grafts, smoking cessation, glycemic control, and enhanced sternal stabilization.
• The decision to use arterial grafts should be a collaborative discussion within the heart team to determine the optimal surgical approach for individual patients.

Outlook:

• Further research into optimizing arterial graft strategies and reducing associated complications is warranted.
• Individualized patient assessment and shared decision-making are crucial for successful CABG outcomes.