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Bilateral Versus Single Internal Thoracic Artery Grafts

Michael Persson1,2, Ulrik Sartipy3,4

  • 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Current Cardiology Reports
|January 25, 2018
PubMed

Insights

Bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) shows improved survival rates. While generally safe, BITA grafting may increase sternal wound infections, particularly in older patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) management has advanced, with graft selection in coronary artery bypass grafting (CABG) remaining a key debate.
  • The use of bilateral internal thoracic artery (BITA) grafts is a significant area of investigation for improving CABG outcomes.

Purpose of the Study:

  • To review the current evidence and status of bilateral internal thoracic artery (BITA) grafting in CABG.
  • To evaluate the scientific data supporting the use of BITA grafts for patients with coronary artery disease.

Main Methods:

  • Review of observational studies and pooled analyses on BITA grafting outcomes.
  • Inclusion of early results from a large randomized controlled trial (RCT) on BITA grafting.
  • Analysis of data regarding survival rates and complications associated with BITA grafts.

Main Results:

  • BITA grafting is associated with improved patient survival compared to other graft types.
  • Early RCT results indicate the safety and efficacy of BITA grafting.
  • Increased sternal wound complications are noted with BITA use, potentially amplified in specific patient groups.
  • The survival benefit of BITA grafts appears most pronounced in patients younger than approximately 69 years.

Conclusions:

  • Coronary artery bypass grafting using BITA grafts likely improves long-term survival but carries a higher risk of sternal wound infections.
  • BITA grafting is considered a safe method for most CABG candidates, with ongoing trials expected to provide definitive evidence.
  • The optimal patient selection for BITA grafting requires careful consideration of age and potential complications.
Abstract

Keywords:
Arterial graftingBITACABGInternal thoracic arteryLong-term survivalSternal wound infections

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