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September 29, 2021

Coronary Artery Bypass Grafting With the Internal Thoracic Artery: A Great Operation With Some Unanswered Questions

Author Affiliations
  • 1Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
  • 2Lifespan Cardiovascular Institute, Providence, Rhode Island
JAMA Cardiol. 2021;6(12):1362-1363. doi:10.1001/jamacardio.2021.3863

In this issue of JAMA Cardiology, Gaudino et al1 published a retrospective analysis of the Arterial Revascularization Trial, evaluating specifically the influence of method of harvest of the internal thoracic artery (ITA) on outcomes after coronary artery bypass grafting (CABG). Surprisingly, patients who had a skeletonized ITA did slightly worse than if the standard pedicled ITA was used. If the ITA is harvested as a pedicled graft, it is taken off the chest wall together with the associated fat and veins and part of the endothoracic fascia, while with the skeletonized method only the artery is separated from the chest wall, sparing some of the vascular supply to the chest wall. One may ask, “Why is this potentially important?” To answer that question, it may be helpful to provide a brief history of CABG.

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