Coronary Revascularization Using Bilateral Internal Thoracic Arteries: Safe with Skeletonization?

Substantial evidence exists to support a long-term survival benefit with bilateral internal thoracic artery (BITA) revascularization in coronary artery bypass grafting. However, this technique remains grossly underutilized worldwide and especially in the United States. In this review, we discuss evidence for the advantages of BITA grafting as well as the associated the risk of sternal wound complications. We then review a growing body of literature that suggests 'skeletonization' of the internal thoracic artery during harvest confers a protective benefit against sternal wound infection in patients receiving BITA.