Pedicled versus skeletonized internal thoracic artery grafts: a randomized trial

Area of Science:

• Cardiovascular Surgery
• Vascular Grafting
• Surgical Techniques

Background:

• Concerns exist regarding potential graft damage and reduced patency with skeletonized internal thoracic artery (ITA) grafts.
• Comparing pedicled versus skeletonized ITA grafts is crucial for optimizing coronary artery bypass grafting (CABG) outcomes.

Purpose of the Study:

• To compare mid- and long-term patency rates of pedicled versus skeletonized left internal thoracic artery (LITA) grafts.
• To evaluate the impact of LITA graft preparation technique on graft survival in CABG patients.

Main Methods:

• A randomized controlled trial involving 109 patients undergoing CABG.
• Patients received either a pedicled or skeletonized LITA graft to the left anterior descending artery.
• Follow-up included conventional angiography at 3 years and CT angiography at 8 years.

Main Results:

• At 3 years, patency rates were 95.8% for pedicled and 90.4% for skeletonized LITA grafts (p=0.44).
• At 8 years, patency rates were 93.0% for pedicled and 90.2% for skeletonized LITA grafts (p=0.71).
• Graft failure was associated with target coronary artery stenosis <70%.

Conclusions:

• Skeletonization of the LITA is a viable technique that does not compromise graft patency.
• Target artery stenosis severity is a critical determinant of LITA graft patency in CABG.