Coronary Artery Bypass Revascularization Using Bilateral Internal Thoracic Arteries in Diabetic Patients: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis explores the literature to determine the relative advantages and disadvantages of using bilateral IMAs over single IMAs on outcomes after CABG in diabetic patients.   In their analysis, the group found that patients who underwent bilateral IMA grafting using skeletonized IMAs had no greater incidence of sternal wound infection than those undergoing unilateral IMA harvesting; however, if the mammaries were harvested on a pedicle, an increased incidence of sternal wound infection was noted in the bilateral harvest group.  In addition, the meta-analysis demonstrated better long-term survival in the bilateral IMA group, regardless of harvesting method, over the unilateral IMA group.  Is it time to reconsider bilateral IMA usage in diabetics?  If bilateral IMAs are indeed used, should they be harvested only in skeletonized fashion?