Internal mammary harvesting: Techniques and evidence from the literature

J Card Surg. 2020 Apr;35(4):860-867. doi: 10.1111/jocs.14459. Epub 2020 Feb 14.

Abstract

Coronary artery bypass graft (CABG) is one of the most commonly performed cardiac surgeries in the world. CABG using the internal mammary artery (IMA) remains the gold standard intervention for myocardial intervention in multivessel coronary artery disease. IMA harvesting can be performed with various techniques and approaches: pedicled vs skeletonized harvesting technique as well as approaches such as conventional sternotomy, robotic and endoscopic approaches. While each technique and approach have their respective advantages and disadvantages, evidence remains varied between cohorts. Traditionally, IMA has been used as an in situ conduit; however, IMA free grafts also provide satisfactory outcomes in certain situations. This literature review aims to explore the efficacy of different techniques and approaches of IMA harvesting and grafting. With evidence compiled, this will provide an overview of the complexity of CABG and locate gaps in current literature to direct future research.

Keywords: coronary artery bypass; harvesting technique; internal mammary.

Publication types

  • Review

MeSH terms

  • Coronary Artery Bypass / methods*
  • Coronary Artery Disease / surgery*
  • Endoscopy / methods
  • Humans
  • Mammary Arteries / surgery*
  • Myocardial Revascularization / methods*
  • Robotic Surgical Procedures / methods
  • Sternotomy / methods
  • Tissue and Organ Harvesting / methods*
  • Tissue and Organ Harvesting / trends
  • Transplants