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Long-Term Clinical and Angiographic Outcomes of Internal Thoracic Artery Harvesting Technique
Marcin Nawotka1, Maciej Peksa1, Lukasz Moskal1
1Department of Cardiac Surgery, Zbigniew Religa Heart Center "Medinet", Nowa Sol, Poland.
Insights
Skeletonized internal thoracic artery (ITA) harvest offers similar long-term outcomes and graft patency compared to pedicled ITA after coronary artery bypass grafting. This technique significantly reduces the risk of deep sternal wound infection.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Concerns exist regarding potential adverse outcomes with skeletonized internal thoracic artery (ITA) harvesting in coronary artery bypass grafting (CABG).
- Investigating the impact of ITA skeletonization versus pedicled harvesting on patient results is crucial.
Purpose of the Study:
- To compare the angiographic and long-term clinical outcomes of skeletonized ITA versus pedicled ITA harvest in CABG patients.
- To assess the effect of ITA harvest technique on sternal wound infection rates.
Main Methods:
- A cohort study included 2909 patients undergoing CABG, divided into skeletonized (n=1440) and pedicled (n=1469) ITA groups.
- Propensity score matching created 961 pairs for analysis of long-term outcomes (mortality, MI, stroke, repeat revascularization, MACCE).
- Graft patency was assessed via follow-up angiography in 806 patients.
Main Results:
- Skeletonized ITA harvest was linked to a 57% reduction in overall sternal wound infection (SWI), primarily driven by decreased deep SWI (OR 0.33).
- No significant differences were observed in superficial SWI, long-term mortality, myocardial infarction, stroke, repeat revascularization, or major adverse cardiac and cerebral events (MACCE) between groups.
- Angiographic follow-up showed comparable ITA graft patency rates: 86.8% for skeletonized vs. 88.6% for pedicled (P=0.39).
Conclusions:
- Skeletonized ITA harvest demonstrates comparable angiographic and long-term clinical outcomes to pedicled ITA harvest in CABG.
- The skeletonized technique is associated with a significant reduction in deep sternal wound infections, improving patient safety.
Introduction:
Recent studies have suggested that skeletonization of the internal thoracic artery (ITA) may be associated with worse angiographic and clinical outcomes after coronary artery bypass grafting. We investigated the impact of ITA skeletonization on angiographic results and long-term clinical outcomes after coronary artery bypass grafting.
Methods:
Between January 2010 and June 2022, 2909 patients met inclusion criteria and were grouped by ITA harvest technique: skeletonized (n = 1440) or pedicled (n = 1469). Propensity score matching yielded 961 pairs. Long-term outcomes included all-cause mortality, myocardial infarction, stroke, repeat revascularization, and major adverse cardiac and cerebral events. Follow-up angiography was available in 806 patients for graft patency assessment.
Results:
In the matched cohort, skeletonization was associated with a 57% lower odds of overall sternal wound infection (SWI) (OR 0.43, 95% CI 0.26-0.71; P < 0.001), driven by reduced deep SWI (OR 0.33, 95% CI 0.17-0.64; P < 0.001), with no significant difference in superficial SWI (OR 0.65, 95% CI 0.61-1.48; P = 0.28). Median clinical follow-up was 6.75 y (IQR 3.54-9.93). Skeletonized and pedicled ITA showed comparable long-term mortality, myocardial infarction, repeat revascularization, stroke, and major adverse cardiac and cerebral events. Among 806 patients with angiography (median 3.72 y; IQR 1.76-6.65), ITA patency was similar between techniques (skeletonized versus pedicled: 86.8% versus 88.6%; P = 0.39).
Conclusions:
Skeletonized ITA harvest is associated with similar angiographic and long-term clinical outcomes compared with pedicled ITA, while reducing deep SWI.
