title: Barriers to the universal adoption of bilateral internal mammary artery grafting.
abstract: The left internal mammary artery (LIMA) graft is considered the "gold standard" of coronary artery bypass grafting (CABG). This conduit provides increased survival, symptomatic relief, increased freedom from myocardial infarction, and increased freedom from re-intervention when compared to saphenous venous grafting. It has a remarkable long term patency rate with clinical and angiographic outcomes that are unmatched by other conduits. Given the fact that patients often require more than one graft during a coronary revascularization procedure, the prospect of bilateral internal mammary artery (BIMA) grafting has been very appealing to some surgeons. BIMA grafting has been extensively studied via multiple retrospective and prospective cohort studies and findings have indicated that BIMA grafting can have an increased survival benefit when compared to LIMA grafting alone. As a result, this technique has accrued increasing popularity over the course of the last decade. Yet, questions still remain on whether BIMA grafting is the optimal treatment modality for patients in terms of long-term prognosis. There is limited data at the present time from randomized controlled trials and only 4-12% of CABGs performed today utilize BIMA grafting. Concerns regarding perioperative complications, which patient subsets are at higher risks for complications from the technique, and the technical challenges involved in utilizing and teaching the technique have limited its widespread use.
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Jeremiah
authors: J
authors: Umakanthan
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Panch
authors: P
authors: Jeyakumar
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Branavan
authors: B
authors: Umakanthan
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Nikeshan
authors: N
authors: Jeyakumar
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Nadarajah
authors: N
authors: Senthilkumar
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Mathioli R
authors: MR
authors: Saraswathy
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Padminidevi
authors: P
authors: Umakanthan
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Janani
authors: J
authors: Umakanthan
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Tamoor
authors: T
authors: Sial
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Sofia
authors: S
authors: Abrina
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Frances M
authors: FM
authors: Buendia
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Irene
authors: I
authors: Pan
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Ramadas K
authors: RK
authors: Kamath
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Canagaratnam
authors: C
authors: Pathmarajah
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Kanagaratnam
authors: K
authors: Sivalingam
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Shan A
authors: SA
authors: Nathan
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Shun K
authors: SK
authors: Sunder
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA.
authors: Tom
authors: T
authors: Mahendra
authors: Olympia Medical Center, 5900 West Olympic Blvd., Los Angeles, CA 90036, USA. Electronic address: rumakanthan@yahoo.com.
authors: Ramanan
authors: R
authors: Umakanthan
mesh_terms: D002983:Clinical Competence; D003324:Coronary Artery Disease / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D059032:Learning Curve; D018579:Patient Selection
keywords: Bilateral internal mammary artery grafting; Coronary artery bypass grafting; Left internal mammary artery grafting