Why did you not use both internal thoracic arteries?

That is the question every cardiologist should ask if the patient he or she has referred for primary surgical coronary revascularization returns from the operating room with a single internal thoracic artery graft. There is a substantial body of evidence demonstrating that the majority of coronary bypass patients benefit more when coronary artery bypass graft (CABG) surgery is performed with both internal thoracic artery conduits rather than just one.1–4 However, only 4.4% of primary isolated CABG cases in the 2011 Society of Thoracic Surgeons National Adult Cardiac Surgery Database received bilateral internal thoracic artery (BITA) grafting.5 There are several putative reasons for this failure of adoption, but referring cardiologists and patients should demand better.