Left Internal Mammary Artery Dissection and Bleeding: A Matter of Trial Design, Not Technique

Abstract

In this issue of The Annals of Thoracic Surgery, Mazur and colleagues1 present the results of a small single-center randomized trial of 62 patients comparing the impact of skeletonized vs pedicled left internal mammary artery (LIMA) harvesting on bleeding after coronary artery bypass grafting. The primary outcome was cumulative mediastinal drainage 12 hours postoperatively, which was found to be 28% lower in patients with skeletonized vs pedicled LIMA. The effort of the Polish group is commendable, but several important issues related to their trial’s methodology must be considered.