Vipin Zamvar of the Royal Infirmary of Edinburgh in the UK discusses the barriers that reduce the use of bilateral internal mammary arteries (BIMAs) in coronary artery bypass surgery. Dr Zamvar focuses on the technical challenges inherent in using BIMAs, important aspects of the alternative options, how the political atmosphere influences the techniques surgeons might use, and the level of evidence for BIMA usage. Finally, he presents suggestions for successfully increasing BIMA grafting.
This presentation was originally given during the SCTS Ionescu University program at the 2017 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please click here for more information on SCTS educational programs.
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2 Comments
Thank you Dr. Zamvar for nice presentation. In situ skeletonization probably helps keeping the microperfusion of sternal bed intact and may benefit by reduction in incidence of deep sternal dehiscence. Skeletonization after harvesting the pedicled IMA graft takes away the advantage.
Thank you.
You are absolutely right, Dr Magotra. A sub-study of the Arterial Revascularisation trial also showed that patients who had the IMAs harvested in a skeletonised fashion, had a lower incidence of sternal wound infection. Skeletonisation, however, is a procedure which takes longer, and there is a chance of injury to the IMA during harvesting. Surgeons who have access to the Harmonic Scalpel, usually find it easier to harvest the IMAs in a skeletonised fashion. In Edinburgh, we do not have access to the harmonic scalpel, and have to rely only on cautery. At the end of the day, each surgeon has to decide what is the best technique in his hands.
Again, Thank you for your comment. Sorry for the delay in replying, I only saw it today. I have very fond memories of the two times I have met you. (In KEM hospital in 1994, and at the IACTS meeting in Bangalore in 2017!!!!)