Abstract
The purpose of this retrospective review was to examine the morbidity and mortality associated with the routine use of skeletonized bilateral internal thoracic arteries (BITA) in coronary bypass surgery (CABG). The current rate of BITA use is reported to be 5% in the US. The literature reflects an increased incidence of wound complications, especially in obese, diabetic, and female patients. Our policy has been to use skeletonized BITA in patients regardless of comorbidities. Using the Society of Thoracic Surgery (STS) database, the postoperative markers of prolonged ventilation (PV), length of stay (LOS), wound infection, death, and 30 day readmission were evaluated for all isolated coronary bypass operations (isocab) to allow comparison of bilateral and single internal thoracic artery (ITA) use during this four year period. The incidence of BITA use was 60%. The groups had similar comorbities and postop complications were similar regardless of single or bilateral thoracic artery use. Specifically, there were no wound complications in the BITA group. Adjuncts such as ITA skeletonization, platelet rich plasma, negative pressure wound dressing, and absence of bone wax were utilized in all cases. The added expense is justified to allow the expanded use of BITA.
Highlights
It is recognized that multiple arterial grafts are preferable in coronary operations. [6, 7] Despite this, bilateral thoracic artery (BITA) use occurs in approximately 5% [1] of isolated coronary operations performed in the US
There was one mortality and one sternal infection, both occurred in the single internal thoracic arteries (ITA) group
There were no differences in prolonged ventilation (PV) or length of stay (LOS) (Figures 5, 6)
Summary
It is recognized that multiple arterial grafts are preferable in coronary operations. [6, 7] Despite this, bilateral thoracic artery (BITA) use occurs in approximately 5% [1] of isolated coronary operations performed in the US. [6, 7] Despite this, bilateral thoracic artery (BITA) use occurs in approximately 5% [1] of isolated coronary operations performed in the US. This is felt to be due to concerns for surgical complications, primarily wound infection. It has been our policy to use BITA grafting in all patients for whom we can use both in continuity, not as a free graft. This is without regard to obesity, diabetes, or female sex. This was felt to be acceptable if they permitted safe extended use of BITA grafting
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