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Interact CardioVasc Thorac Surg 2005;4:577-582. doi:10.1510/icvts.2005.118935
© 2005 European Association of Cardio-Thoracic Surgery
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Shahzad G. Raja
Joel Dunning
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Best evidence topic - Cardiac general

Is skeletonised internal mammary harvest better than pedicled internal mammary harvest for patients undergoing coronary artery bypass grafting?

Ali Asgar Behranwalaa, Shahzad G. Rajaa and Joel Dunningb,*

a Department of Cardiothoracic Surgery, Alder Hey Hospital, Liverpool, UK
b Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel./fax: +44-7801548122.

E-mail address: joeldunning{at}doctors.org.uk (J. Dunning).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether skeletonised internal mammary artery (IMA) is better than pedicle IMA in coronary artery bypass grafting? Altogether 106 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that skeletonisation increases the length of conduit by around 3 cm and may also increase flow and conduit diameter. Skeletonisation should be the technique of choice for diabetics in whom BIMA harvest is desired, but at the expense of an extra 15–20 min per operation, no convincing outcome benefits have been shown for single IMA harvest.

Key Words: Skeletonised; Mammary arteries; Evidence-based medicine; Thoracic surgery

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