Bilateral internal thoracic artery grafting in India-Time to raise the bar.
OBJECTIVES
Bilateral internal thoracic artery (BITA) grafting strategy is the current trend in coronary artery bypass grafting for multivessel coronary artery disease. Although better long-term outcomes have been shown, BITA grafting is underutilized as a main strategy for revascularization by most of the surgeons. The survey was conducted to ascertain the current usage and concerns of BITA grafting in India.


METHODS
Database of 856 Indian cardiac surgeons currently with predominantly adult practice was prepared and a questionnaire was sent about use of single and bilateral ITA grafts and BITA grafting strategy in different clinical scenarios.


RESULTS
A total of 112 surgeons (13.08%) from 75 institutions responded and 92 surgeons (10.7%) completed the survey. Single ITA is used by 79% of surgeons in more than 90% of their patients. 31% and 29% of surgeons use BITA grafting in 5-10% and 11-98% of their patients respectively. 53% of surgeons avoided the usage of BITA grafting in patients with smoking, 35% of surgeons in chronic obstructive pulmonary disease, 58% of surgeons in obesity and 62% of surgeons in acute coronary syndrome, 36% of surgeons in patients with left ventricular dysfunction and 61% of surgeons in patients with poor coronary anatomy. The concerns for BITA usage are risk of deep sternal wound infection (DSWI) (40%), increased operative time (27%), unknown superiority (12%) and limited length of right ITA (5%).


CONCLUSIONS
The usage of BITA grafting is restricted to 10% in India and main concerns are DSWI and increased operative time.
['Sajja|Lokeswara Rao|LR|', 'Beri|Prashanthi|P|']
D000328:Adult D002983:Clinical Competence D001026:Coronary Artery Bypass D003324:Coronary Artery Disease D005260:Female D006801:Humans D007194:India D008297:Male D008323:Mammary Arteries D008875:Middle Aged D061646:Operative Time D012189:Retrospective Studies D066231:Surgeons D011795:Surveys and Questionnaires D013997:Time Factors D055815:Young Adult
Bilateral internal thoracic artery Coronary artery bypass grafting Deep sternal wound infection Single internal thoracic artery