Bilateral Semi-Skeletonized IMA; Less Thermal Injury, Easier to Harvest, Early Post Operative Comparison with Single IMA Patients After CABG

The use of BITA is prominent in coronary bypass surgery due to its positive effects on long-term mortality and morbidity. However, its use is not widespread enough among heart surgeons due to its technical difficulty and the longer period of time it requires. There are still many articles being published on the subject. In patients who receive BITA, harvesting is usually performed in a skeletonized fashion. This protects the patient from sternal complications because it disturbs the vascularity of the chest wall less compared to the pedicled technique. However, the risk for injury on IMA is high. This is where harvesting in semi-skeletonized fashion distinguishes itself. Not only does it disturb the vascularity of the chest wall less but it also has a lower risk for thermal injury. Furthermore, it provides some advantages in terms of time over skeletonized fashion. The study enrolled 24 patients who underwent an isolated CABG operation using cardiopulmonary bypass (CPB) by a single surgeon between March 2017 - December 2017. 12 patients (10 males, 2 females; mean age: 55.083) underwent CABG operation using semi-skeletonized BITA (Table 1). Another 12 patients (8 males, 4 females; mean age: 56.25) underwent CABG using LIMA and venous graft. Post-operative sternal wound complications and post-operative pain of patients were compared. In the patients of the BITA group, cross clamp time, operation time and mammary harvesting time caused a slight prolongation. None of patients had deep sternal infection or mediastinitis or mechanical sternal dehiscence. BITA harvesting patients had more postoperative pain. As a result using semi-skeletonized ITA is more beneficial for sternal wound recovery compared to IMA harvested with the pedicled technique because the former causes less trauma in the thorax and disturbs the bleeding of the chest wall less. Furthermore, we think that it has advantages in terms of time and less traumatic effects on ITA compared to ITA harvested in a skeletonized fashion.