Sternal wound management after bilateral internal thoracic artery grafting: a significant detail
Throughout the last 20 years, many—prospective and retrospective—observational studies have shown longterm survival benefits derived from the use of bilateral internal thoracic artery (BITA) grafts for myocardial revascularization (BITA grafting). Outcomes of large cohorts of BITA patients have been reviewed. Pooled analyses of these studies suggest that, at 10 years, there are approximately 20% fewer all-cause deaths with BITA grafting than with the standard model of myocardial revascularization, i.e., single internal thoracic artery (SITA) graft to the left anterior descending coronary artery (SITA grafting), and saphenous vein grafts (SVGs) for the remaining diseased coronary vessels (1-3). The benefits arise mainly from the higher late patency of internal thoracic artery (ITA) graft versus SVG, even for difficult subset of patients such as diabetics. In fact, the SITA graft has a 10-year rate of angiographic patency exceeding 90%, as compared with 50% for SVG, having the radial artery (RA) an intermediate performance (4-6).