Changing pattern in beating heart operations: use of skeletonized internal thoracic artery.
BACKGROUND
The use of skeletonized internal thoracic artery (ITA) was reported to be technically and hemodynamically beneficial in conventional coronary artery bypass grafting with cardiopulmonary bypass assistance. The purpose of this study is to evaluate the impact of changing from conventional to skeletonized ITA harvesting on early off-pump coronary artery bypass grafting outcome.


METHODS
Between 1996 and 2001, 640 patients underwent systematic off-pump coronary artery bypass grafting (single surgeon experience). The ITA was pedicled (P) in the first consecutive 440 patients and skeletonized (S) in the subsequent 200 consecutive patients. Mean age, preoperative risk factors, sex, number of involved territories, and incidence of reoperations were similar in both groups.


RESULTS
In group S, number of ITAs per patient (1.7 +/- 0.08 versus 1.2 +/- 0.05; p < 0.001), bilateral ITA (46% versus 27%; p < 0.001), ITA sequential grafts (27% versus 1%; p < 0.001), and T grafts (16% versus 3%; p < 0.001) were higher. Deep sternal infections were comparable in both groups (group S: 1%, group P: 1.2%; p = 0.38). Perioperative myocardial infarction, maximal creatinine kinase-MB level, and requirement for more than 24 hours of inotropic support were comparable in both groups. Thirty-day mortality was also similar (S: 1.7%, P: 1.6%).


CONCLUSIONS
Changing to routine use of skeletonized ITA in off-pump coronary artery bypass grafting is a safe alternative to routine pedicled ITA. In our experience, this procedure has facilitated the use of ITA anastomosis without increasing sternal wound complications.
Cartier
Raymond
R
Department of Surgery, Montreal Heart Institute, Quebec, Canada. rc2910@aol.com
Leacche
Marzia
M
Couture
Pierre
P
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009204:Myocardial Revascularization / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate