Harvesting internal mammary artery: a narrative review.

Scientific literature has highlighted the development of surgical procedures with studies investigating optimal selection of arterial conduit, ideal harvesting method and type of graft. There have also been studies on the utility and efficiency of harvesting the internal mammary artery (IMA) through minimally invasive techniques such as endoscopic and robotic assisted methods. In the pursuit of a more total and complete revascularization of the coronary arteries, surgeons have also explored more extensive anastomosis techniques, i.e. sequential and no-touch. This review analyzes the literature in order to better understand the various methods for harvesting and using the IMA in coronary artery bypass graft (CABG) through outlining the pros and cons of each methodology. Literature search on PubMed and Google Scholar was performed using search terms such as "CABG," "IMA," "internal thoracic artery," "harvesting," "technique," and "approach." Manuscripts in languages other than English were not considered. Manuscripts that assess outcomes of IMA harvesting are reviewed and included. A review of 48 studies, narrowed down from 150 articles that were retrieved, were used to evaluate current evidence for different IMA harvesting techniques. This includes evidence comparing various techniques: skeletonized and pedicled harvesting, minimally invasive techniques for harvesting; free arterial and in-situ grafts; no-aortic touch technique sequential grafting. Each technique and harvesting method is associate with various advantages and disadvantages. Common patterns in patient outcomes were identified for many of the techniques. This review provides a summary and overview of the current evidence base for CAGB surgery and identifies gaps in the evidence base to direct future research.