Bilateral Internal Mammary Artery Grafting

Coronary artery bypass grafting (CABG) remains the preferred revascularization option for patients with complex multi-vessel coronary artery disease. The standard grafting strategy in multi-vessel CABG involves the use of left internal mammary artery (IMA) for grafting of the left anterior descending artery and supplemental saphenous veins for all other target vessels. However, there is emerging evidence predominantly from retrospective, observational studies suggesting improved long-term outcomes with the use of bilateral IMAs. Despite the reported benefits of bilateral IMAs, most surgeons are reluctant to use both IMAs as it is a technically more demanding and time-consuming strategy with marginally higher sternal wound infection rates. This chapter provides an overview of bilateral IMA grafting exploring the rationale, surgical aspects as well as outcomes, concerns and controversies associated with this strategy.