Bilateral internal thoracic arteries: what is the State of the ART?. (September 2017)

• Record Type: Journal Article
• Authors: Yanagawa, Bobby; Verma, Subodh; Puskas, John D.
• Is Part Of: Current opinion in cardiology. Volume 32:Number 5(2017:Sep.)
• Publication Date: 2017-09
• Subjects: arterial revascularization -- bilateral internal thoracic artery -- coronary artery bypass graft; Cardiology -- Periodicals; Cardiology -- Periodicals; Heart Diseases -- Periodicals; Cardiology; Periodicals; 616.12
• DOI: 10.1097/HCO.0000000000000431
• Languages: English
• ISSNs: 0268-4705

Abstract

Abstract : Purpose of review: To provide a broad overview of the current state of knowledge of coronary artery bypass grafting with bilateral internal thoracic artery (BITA). Recent findings: There exists a large body of literature from mostly observational studies supporting the use of BITA in patients undergoing coronary artery bypass grafting but selection bias is a major issue with nonrandomized data. The precise method of BITA use does not appear to impact graft patency nor clinical outcomes – in other words, BITA in any configuration appears to be protective. The major downside is the increased risk of sternal complications, which can be mitigated with sternal-sparring adjuncts. The 5-year interim results of the landmark Arterial Revascularization Trial comparing BITA versus single internal thoracic artery did not show a clinical benefit for BITA but the end-of-trial results are pending. Despite wide guideline support for BITA use, uptake in the surgical community remains low and this is likely because of technical and institutional barriers. Summary: The published literature thus far supports surgical revascularization with BITA and we eagerly await the 10-year Arterial Revascularization Trial results. The general consensus is that a greater proportion of surgical revascularization should be performed using BITA.