Long-Term Clinical and Angiographic Outcomes of Internal Thoracic Artery Harvesting Technique.

INTRODUCTION

Recent studies have suggested that skeletonization of the internal thoracic artery (ITA) may be associated with worse angiographic and clinical outcomes after coronary artery bypass grafting. We investigated the impact of ITA skeletonization on angiographic results and long-term clinical outcomes after coronary artery bypass grafting.

METHODS

Between January 2010 and June 2022, 2909 patients met inclusion criteria and were grouped by ITA harvest technique: skeletonized (n = 1440) or pedicled (n = 1469). Propensity score matching yielded 961 pairs. Long-term outcomes included all-cause mortality, myocardial infarction, stroke, repeat revascularization, and major adverse cardiac and cerebral events. Follow-up angiography was available in 806 patients for graft patency assessment.

RESULTS

In the matched cohort, skeletonization was associated with a 57% lower odds of overall sternal wound infection (SWI) (OR 0.43, 95% CI 0.26-0.71; P < 0.001), driven by reduced deep SWI (OR 0.33, 95% CI 0.17-0.64; P < 0.001), with no significant difference in superficial SWI (OR 0.65, 95% CI 0.61-1.48; P = 0.28). Median clinical follow-up was 6.75 y (IQR 3.54-9.93). Skeletonized and pedicled ITA showed comparable long-term mortality, myocardial infarction, repeat revascularization, stroke, and major adverse cardiac and cerebral events. Among 806 patients with angiography (median 3.72 y; IQR 1.76-6.65), ITA patency was similar between techniques (skeletonized versus pedicled: 86.8% versus 88.6%; P = 0.39).

CONCLUSIONS

Skeletonized ITA harvest is associated with similar angiographic and long-term clinical outcomes compared with pedicled ITA, while reducing deep SWI.