Comparative Outcomes of Mammary Artery Harvesting: Infection, Occlusion Rates and Thoracic Pain Assessment

The COMFORT Trial is a randomized controlled superiority trial comparing skeletonized (SK) versus non-skeletonized (non-SK) harvesting of the left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft in patients undergoing isolated coronary artery bypass grafting (CABG).

Inclusion Criteria: 1. Age 18 years or older 2. Undergoing isolated CABG surgery with median sternotomy and a planned LIMA-LAD graft 3. Provision of written informed consent Exclusion Criteria: 1. Non-sternotomy surgical approach (e.g., minimally invasive, thoracotomy) 2. Emergency surgery (defined as surgery required within 24 hours of presentation) 3. History of prior sternotomy 4. Currently receiving systemic antibiotics or with an active bacterial infection at the time of surgery 5. History of chronic sternal pain prior to the index surgery 6. Known left subclavian artery stenosis (\>50%) 7. Previous radiation therapy to the chest 8. Known allergy or contraindication to iodinated contrast media that cannot be managed with premedication 9. Estimated glomerular filtration rate (eGFR) \