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(Circulation. 2008;118:697-698.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Routine Use of Bilateral Skeletonized Internal Thoracic Artery Grafting: Long-Term Results

 
Recent studies have shown survival benefit and freedom from reintervention with the use of 2 internal thoracic arteries (ITAs) compared with a single ITA. However, in most of these studies, bilateral ITA (BITA) grafting is offered to only a selected group of nonurgent, nondiabetic young patients. Unlike those reports, our study describes long-term results of BITA grafting in nonselected patients. The study includes many elderly, emergency, and diabetic patients who would not otherwise be referred for BITA grafting. In most centers, the ITA is isolated from the chest wall as a pedicle, together with the vein, muscle, fat, and accompanying endothoracic fascia. This technique damages blood supply to the sternum, which in turn impedes sternal healing and exposes the sternum to the risks of early dehiscence and infection in operations involving both ITAs. The risk of sternal infection is particularly high in patients with preoperatively limited sternal blood supply such as the elderly and those with diabetes mellitus. Harvesting the ITA as a skeletonized artery preserves sternal collateral blood supply, thus enabling more rapid healing and lower risk of infection. We have found that skeletonized BITA grafting is associated with low morbidity and good long-term results. Use of skeletonized BITA was found to be an appropriate technique for the elderly and most patients with diabetes mellitus. However, in patients with chronic lung disease, in repeat operations, and in obese and female diabetic patients, the risk of sternal infection is still unacceptably high; for these patients, we advocate operations incorporating only . . . [Full Text of this Article]

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