Methods: Forty patients undergoing coronary artery bypass surgery were randomized into two groups. Bilateral ITA was used in group 1 (n=20; 16 men, 4 women; mean age 62±8 years; range 44 to 68 years), while the left ITA was used in group 2 (n=20; 14 men, 6 women; mean age 65±6 years; range 46 to 72 years). Sternum SPECT was performed before surgery and in early (mean 6.4±1.1 days) and late (mean 135.9±14.1 days) postoperative periods for comparison of sternal vascularity.

Results: Preoperative and intraoperative findings were similar in two groups except for the operation time, which was significantly shorter in group 2. Preoperative SPECT findings were similar, as well. Early postoperative scans showed dramatic decreases in blood flow into both sides of the sternum in both groups (p<0.001). On late postoperative scans, sternal vascularity was still significantly less than the preoperative values on both sides of the sternum in both groups; however, it was significantly improved compared to the early postoperative period. While vascularity of the sternal sides did not differ on both early and late postoperative scans in group 1, reduction in vascularity to the right side of the sternum was significantly less in group 2 (p<0.001 and p=0.01, respectively). Sternal infections were seen in three diabetic patients (2 superficial, 1 deep) in group 1, compared to no complications in group 2.

Conclusion: The use of bilateral ITA is associated with significantly decreased sternal vascularity in the early postoperative period, which then shows partial improvement in time. While bilateral ITA harvesting should be avoided in risky patients, its benefits such as improved survival and better revascularization should not be overlooked in selected cases.