Which statement best reflects the risk profile of IMA grafts?

• A. No healing issues.
• B. No increased risk for mediastinitis.
• C. They pose no risk for infection.
• D. Potential healing problems and increased risk for mediastinitis.

Answer: (D)

The key idea here is that while internal mammary artery (IMA) grafts have excellent long-term patency and a favorable infection profile, they are not without risks. Harvesting the IMA can affect blood supply to the sternum, especially when both IMAs are used (bilateral harvest). This can lead to healing problems at the sternotomy site and, in some patients, an increased risk of sternal wound infection and mediastinitis. Factors such as diabetes, obesity, reoperation, and overall wound healing capacity can further elevate this risk.

So the statement that best fits the reality is that there can be healing problems and an increased risk for mediastinitis. The ideas that there would be no healing issues, no increased mediastinitis risk, or no infection risk are too absolute and don’t reflect these possible complications, even though the overall graft strategy has many advantages.