Benefit of partial right-bilateral internal thoracic artery harvesting in patients at risk of sternal wound complications.
BACKGROUND
Excellent long-term patency of the internal thoracic artery (ITA) graft promotes use of bilateral ITA bypass grafting; sternal devascularization, however, increases the risk of wound complications. We hypothesized that restricting right ITA (RITA) harvesting to a short proximal skeletonized segment (3 to 5 cm) would result in adequate residual blood supply to reduce that risk.


METHODS
Seventy-eight patients with numerous risk factors for wound complications underwent composite double ITA grafting, utilizing the RITA segment anastomosed to the left skeletonized ITA and to the obtuse marginal branch in Y fashion. Blood flow in the distal RITA was assessed by parasternal transthoracic Doppler ultrasonography. Comparisons were made with prospectively collected data of patients undergoing pedicled single (n = 160) or skeletonized bilateral ITA grafting (n = 143) during the same period.


RESULTS
Incidence of obesity, chronic obstructive pulmonary disease, diabetes, and peripheral vascular disease was higher in study patients. Postoperative Doppler ultrasonography detected reversed systolic dominant flow pattern. Wound complications occurred in 2 of 78 (2.6%) patients, compared with 14 of 143 (9.8%) after bilateral ITA (p = 0.04) and 8 of 160 (5%) after single ITA grafting (p = ns). Technique of bilateral ITA harvesting (partial right versus full length; odds ratio, 0.2; confidence interval: 0.04 to 0.9) and diabetes mellitus (odds ratio, 2.7; 95% confidence interval: 1.1 to 6.3) were independent predictors of wound complications in the entire series.


CONCLUSIONS
Substantial residual blood supply is detectable after partial RITA harvesting and may prevent wound complications in high-risk patients.
Zeitani
Jacob
J
Division of Cardiac Surgery, Tor Vergata University, Rome, Italy. zeitani@hotmail.com
Penta de Peppo
Alfonso
A
De Paulis
Ruggero
R
Nardi
Paolo
P
Scafuri
Antonio
A
Nardella
Saverio
S
Chiariello
Luigi
L
D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery* / Q000637:transplantation; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012306:Risk; D013249:Sternum / Q000098:blood supply / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D018608:Ultrasonography, Doppler