Bilateral internal thoracic arteries: What is the State of the ART?

Bobby Yanagawa, Subodh Verma, John D. Puskas

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Purpose of review To provide a broad overview of the current state of knowledge of coronary artery bypass grafting with bilateral internal thoracic artery (BITA). Recent findings There exists a large body of literature from mostly observational studies supporting the use of BITA in patients undergoing coronary artery bypass grafting but selection bias is a major issue with nonrandomized data. The precise method of BITA use does not appear to impact graft patency nor clinical outcomes-in other words, BITA in any configuration appears to be protective. The major downside is the increased risk of sternal complications, which can be mitigated with sternal-sparring adjuncts. The 5-year interim results of the landmark Arterial Revascularization Trial comparing BITA versus single internal thoracic artery did not show a clinical benefit for BITA but the end-of-trial results are pending. Despite wide guideline support for BITA use, uptake in the surgical community remains low and this is likely because of technical and institutional barriers. Summary The published literature thus far supports surgical revascularization with BITA and we eagerly await the 10-year Arterial Revascularization Trial results. The general consensus is that a greater proportion of surgical revascularization should be performed using BITA.

Original languageEnglish
Pages (from-to)594-599
Number of pages6
JournalCurrent Opinion in Cardiology
Issue number5
StatePublished - 1 Sep 2017


  • arterial revascularization
  • bilateral internal thoracic artery
  • coronary artery bypass graft


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