title: Off-pump Bilateral Internal Thoracic Artery Grafting.
abstract: BACKGROUND
  The long-term benefit of bilateral internal thoracic grafts (BITA) is well established. BITA grafting is often avoided in diabetic, female, obese, elderly and other high-risk patients because of concerns for deep sternal wound infection. The objective of this study is to analyse early results of our BITA grafting and to establish the safety of BITA use in all patients.
  
  
  METHODS
  All cases of isolated consecutive unselected CABG were included in this retrospective study. BITA were used in-situ - one was used to graft left anterior descending artery and the other was used as inflow for a composite graft with radial artery. Dual inflow using in situ BITA grafting allows easy bailout by using an additional vein graft.
  
  
  RESULTS
  BITA was used in 574 patients out of 602 (95.35%). Incidence of early death was 1.33% (8/602), stroke 0.5% (3/602), reoperation for bleeding 0.17% (1/602). Deep sternal wound infection was not seen in any patient but nine patients (1.5%) had superficial wound infection which healed with dressing.
  
  
  CONCLUSIONS
  We have used BITA in 95% of our unselected, consecutive off-pump CABG patients without any major wound complications. Our limited experience has shown off-pump CABG using BITA grafting can be safely adopted routinely with excellent early result.
authors.affiliation: Private practice, multiple private hospitals in Mumbai, India; Fortis S. L Raheja Hospital, Mumbai, India. Electronic address: kamalessk@gmail.com.
authors.forename: Kamales Kumar
authors.initials: KK
authors.lastname: Saha
authors.affiliation: Fortis S. L Raheja Hospital, Mumbai, India.
authors.forename: Mandar M
authors.initials: MM
authors.lastname: Deval
authors.affiliation: Private practice, multiple private hospitals in Mumbai, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Gandhi Medical College, Bhopal, India.
authors.forename: Ram P
authors.initials: RP
authors.lastname: Kaushal
authors.affiliation: Private practice, multiple private hospitals in Mumbai, India.
authors.forename: Kakalee K
authors.initials: KK
authors.lastname: Saha
authors.affiliation: Private practice, multiple private hospitals in Mumbai, India.
authors.forename: Rinu V
authors.initials: RV
authors.lastname: Jacob
authors.affiliation: Private practice, multiple private hospitals in Mumbai, India.
authors.forename: Ratnaprobha
authors.initials: R
authors.lastname: Adsul
authors.affiliation: Fortis S. L Raheja Hospital, Mumbai, India.
authors.forename: Lukash
authors.initials: L
authors.lastname: Jagdale
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control
keywords: Anaortic off-pump CABG; Bilateral internal thoracic artery grafting; CABG arterial graft; CABG new technology; Coronary artery bypass graft CABG; Off-pump surgery