Summary
This analysis of the Arterial Revascularization Trial (ART) examined whether ITA harvesting technique influenced long-term outcomes in 2,161 CABG patients over 10 years. Whilst all-cause mortality did not differ significantly between skeletonized and pedicled groups, skeletonized ITA harvesting was associated with significantly higher risks of major adverse cardiac events and sternal complications. Notably, this difference disappeared when analysis was restricted to more experienced surgeons (those enrolling ≥51 patients), suggesting surgeon experience may modulate technique-related risk.
UK applicability
These findings are directly relevant to UK cardiac surgery practice, where both ITA harvesting techniques are employed. The results suggest that surgical experience with technique selection is critical; they support the importance of centralisation and surgeon training in minimising adverse outcomes with skeletonized ITA harvesting.
Key measures
Hazard ratios for all-cause mortality, MACE (comprising all-cause mortality, myocardial infarction, and repeated revascularisation), and MACE plus sternal wound complications at 10 years; Cox regression and propensity score matching employed
Outcomes reported
The study compared long-term clinical outcomes between two internal thoracic artery (ITA) harvesting techniques—skeletonized versus pedicled—in coronary artery bypass graft (CABG) patients over 10 years. Primary outcome was all-cause mortality; secondary outcomes included major adverse cardiac events (MACE) and sternal wound complications.
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