Skeletonized internal thoracic arteries for CABG surgery: a new gold standard?
Subodh Verma* and Christopher M Feindel
Correspondence *Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
Email subodh.verma@sympatico.ca
This article has no abstract so we have provided the first paragraph of the full text.
The low mortality and excellent symptom relief associated with CABG surgery are largely attributable to the use of ITAs to bypass the left anterior descending coronary artery. ITAs have traditionally been harvested within a tissue pedicle, which includes the artery, ITA veins, endothoracic fascia, and fat. This technique causes substantial reductions in ipsilateral sternal blood flow, and can almost completely devascularize the sternum if employed bilaterally—particularly in individuals with diabetes—predisposing the patient to increased rates of sternal infections.1 Preservation of the sternal–anterior intercostal arterial trunk can prevent decrements in sternal blood flow, but the integrity of this circuit is often disrupted during pedicled ITA harvest.
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