Current Readings: Single vs Bilateral Internal Mammary Artery in Coronary Artery Bypass Grafting

There is strong retrospective data demonstrating that bilateral internal mammary artery (BIMA) grafting leads to better long-term survival as compared to left internal mammary artery grafting. However, this survival advantage was not corroborated by the interim results of the Arterial Revascularization Trial. Today, there are barriers to widespread adoption of BIMA grafting. One of the main disadvantages of the use of BIMA grafts is the higher risk of deep sternal wound infection. Deep sternal wound infections can be minimized by skeletonized harvesting of the internal mammary artery grafts, which preserve blood flow to the sternum. Also, utilizing the BIMA graft as a “Y” graft may lead to more complete revascularization compared to its in situ use. BIMA grafting on average takes 25 minutes longer operating time with a higher in-hospital costs. We eagerly await the 10-year results of the Arterial Revascularization Trial to determine the truly unbiased randomized long-term effectiveness of BIMA grafting. © 2018 Elsevier Ltd