Feasibility and suitability of the routine use of bilateral internal thoracic arteries

Does bilateral ITA grafting increase perioperative complications?☆Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass

“…Hirotani et al [13] observed no difference in the incidence of chest wound infection in 200 patients with BITA and 43 patients with unilateral ITA grafting, although 127 diabetic patients were included.…”

“…After 10 years, patency rate of LITA amounts to about 90% versus only 50-60% for saphenous veins, resulting in improved long-term survival of patients receiving LITA [1,[2][3][4][5][11][12][13]16,17,15]. An additional benefit concerning longterm morbidity and mortality was described after a surgical technique revascularizing preferentially left-sided coronary arteries (LAD and circumflex artery) with both ITAs [1,3,5,11,14,15].One of our studies, concerning angiographic findings in midterm follow-up (mean 2.7 years) of 663 symptomatic patients, showed the unambiguous superior patency of ITA, especially BITA grafts to saphenous veins in a negative-selected, symptomatic large patient population [9].…”

“…Imperfect outcomes were described for right internal thoracic artery (RITA) to RCA bypasses [9,10]. Studies in which RITA and left internal thoracic artery were used to bypass preferentially important vessels of the left coronary system showed excellent results [9,[2][3][4][5][11][12][13], and superior graft patency [9,[2][3][4][5][11][12][13][14][15] with long-term freedom of cardiac events and reoperations.…”

“…Respecting excellent long-term results of other groups [1,[2][3][4][5][11][12][13]16,17,15] after revascularizing important left coronary vessels with both in situ ITAs, we have attempted routinely -since 1997 -a surgically standardized technique to revascularize the left anterior descending artery with the RITA anterior to the aorta, and circumflex artery, or a dominant branch on the lateral wall, with the LITA.…”

Off-pump coronary artery bypass grafting using in situ bilateral skeletonized internal thoracic arteries

“…11 Most recent reports have supported the use of bilateral ITAs because of improved long-term results. 12,13 Therefore, use of bilateral ITAs may become a routine procedure in the future.…”