title: Use of bilateral internal thoracic artery during coronary artery bypass graft surgery in Canada: The bilateral internal thoracic artery survey.
abstract: OBJECTIVE
  The internal thoracic artery is the gold standard conduit in coronary artery bypass grafting. Although the right and left internal thoracic arteries are excellent conduits, the use of the bilateral internal thoracic artery is not widespread. A recent report of the Society of Thoracic Surgery revealed that only a small percentage of patients receive a bilateral internal thoracic artery in North America. The aim of this study was to determine the current use of the bilateral internal thoracic artery during coronary artery bypass grafting among cardiac surgeons in Canada and identify the main concerns that limit the use of these conduits.
  
  
  METHODS
  We developed an online survey with 17 questions about the use of the bilateral internal thoracic artery in different clinical scenarios. An invitation to participate was sent to all the adult cardiac surgeons currently in practice in Canada.
  
  
  RESULTS
  A total of 101 surgeons (69%) of 147 currently in practice across 27 different hospitals completed the survey. Forty percent of surgeons use the bilateral internal thoracic artery only sometimes (6%-25% of cases), 37% of surgeons use the bilateral internal thoracic artery very infrequently (<5% cases), 16% of surgeons use the bilateral internal thoracic artery often (26%-50%), and only 7% of surgeons use the bilateral internal thoracic artery very often (>50%). The most common concerns in the use of the bilateral internal thoracic artery are the risk of sternal wound infection and the unknown superiority of the right internal thoracic artery over other conduits.
  
  
  CONCLUSIONS
  The majority of Canadian cardiac surgeons consider few clinical features, such as insulin-dependent diabetes mellitus or morbid obesity, as contraindications to the use of bilateral internal thoracic artery. However, the reported use of the bilateral internal thoracic artery is low. A wider diffusion of this technique is warranted to improve the results of coronary surgery.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mastrobuoni
authors.forename: Nada
authors.initials: N
authors.lastname: Gawad
authors.forename: Joel
authors.initials: J
authors.lastname: Price
authors.forename: Vincent
authors.initials: V
authors.lastname: Chan
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Mesana
authors.forename: Fraser D
authors.initials: FD
authors.lastname: Rubens
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D016009:Chi-Square Distribution; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000706:statistics & numerical data*; D020407:Internet; D008323:Mammary Arteries / Q000601:surgery*; D018579:Patient Selection; D010465:Perception; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D011795:Surveys and Questionnaires