Bilateral internal mammary artery grafting for CABG
Advantage of bilateral internal mammary artery grafting (BIMA grafting) for coronary artery bypass grafting over using a single arterial conduit (left internal mammary artery) is a better survival documented by a meta analysis of 9 observational studies involving over fifteen thousand patients with follow up over 9 years . But there is a reluctance of some cardiac surgeons to use both internal mammary arteries for fear of deep sternal wound infections, often causing mediastinitis. Important risk factors for deep sternal wound infections are:
Chronic obstructive pulmonary disease
Use of skeletonized internal mammary artery grafts instead of pedicled grafts can reduce the risk of sternal wound infection as the sternal vasculature is maintained while harvesting skeletonized grafts. Reference
Yi G, Shine B, Rehman SM, Altman DG, Taggart DP. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation. 2014;130:539-545.