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Bilateral Internal Thoracic Artery Grafting: Current State of the Art

Kinoshita, Takeshi MD; Asai, Tohru MD, PhD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: March-April 2011 - Volume 6 - Issue 2 - p 77-83
doi: 10.1097/IMI.0b013e3182166793
Review Article

The purpose of this article is to review the key literature and assess the current status of bilateral internal thoracic artery grafting. Numerous retrospective studies have demonstrated a benefit of bilateral internal thoracic artery grafting over single internal thoracic artery grafting in terms of the long-term risk of all-cause death, cardiac-related death, and cardiac events. The survival benefit of bilateral internal thoracic artery grafting manifests relatively early after operation for high-risk patients. The skeletonization technique reduces the risk of sternal wound complications in all patients and particularly in those with diabetes. Both the left and right internal thoracic arteries have better patency when grated to the left coronary territory than saphenous vein. However, the right internal thoracic artery does not always have good patency when grafted to the right coronary artery. Bilateral internal thoracic artery grafting using the skeletonization technique is recommended for revascularization of the left coronary territory.

From the Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan.

Accepted for publication November 11, 2010.

Address correspondence and reprint requests to Takeshi Kinoshita, MD, Shiga University of Medical Science, Setatsukinowa, Otsu 520-2192, Japan. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.