TY - JOUR AU - Tribble, Curtis G PY - 2017/08/28 Y2 - 2024/03/28 TI - The Skeleton in the Closet: Harvesting a Skeletonized IMA JF - The Heart Surgery Forum JA - HSF VL - 20 IS - 4 SE - DO - 10.1532/hsf.1867 UR - https://journal.hsforum.com/index.php/HSF/article/view/1867 SP - E178-E183 AB - <p>There is a considerable amount of data that using more than one arterial graft provides a survival advantage for patients undergoing coronary bypass operations. The Society of Thoracic Surgeons has a set of official guidelines for the use of arterial grafts which include the following recommendations:</p><ul><li>Internal mammary arteries (IMA’s) should be used to bypass the left anterior descending (LAD) artery when bypass of the LAD is indicated.</li><li>As an adjunct to left internal mammary artery (LIMA), a second arterial graft (right IMA or radial artery [RA]) should be considered in appropriate patients.</li><li>Use of bilateral IMA’s (BIMA’s) should be considered in patients who do not have an excessive risk of sternal complications.</li><li>To reduce the risk of sternal infection with bilateral IMA’s, skeletonized grafts should be considered, smoking cessation is recommended, glycemic control should be considered, and enhanced sternal stabilization may be considered.</li><li>Use of arterial grafts should be a part of the discussion of the heart team in determining the optimal approach for each patient.</li></ul><p>         [Ann Thorac Surg 2016; 101: 801–9] </p> ER -