Is It True Bilateral Internal Thoracic Artery Harvest for Coronary Artery Bypass Grafting Increase the Risk of Mediastinitis

Abstract

Summary: The single internal thoracic artery (SITA) has been used almost exclusively as a pedicled graft. Many publications report that bilateral pedicled internal thoracic artery (ITA) grafting increases the risk of mediastinitis. Recently in order to gain the additional length, increase the number of arterial anastomoses and decrease the occurrence of deep sternal infections, there has been an increasing popularity of bilateral use of the skeletonized internal thoracic artery (ITA) for CABG. The aim of this article is to review English literature from multicenter and different cardiac surgeon's experiences regarding this fact. We used terms bilateral mammary harvesting, harvesting of bilateral mammary, mediastinitis and related keywords to search MEDLINE, other literature databases and article reference lists for English-language single versus bilateral internal mammary artery for coronary artery bypass grafting that were published from 1990 – December, 2007. Current available evidence shows that skeletonized BITA grafting carries an acceptable risk of deep sternal infection but is not recommended for repeat CABG or for patients with chronic obstructive pulmonary disease (COPD). Skeletonized BITA grafting can be safely applied in almost every patient. All cardiac surgeons should be trained efficiently in using skeletonized BITA.