title: Effects of pleurotomy on respiratory sequelae after internal mammary artery harvesting.
abstract: The preservation of pleural integrity during mammary artery harvesting may decrease atelectasis and pleural effusion during the postoperative period. We designed this retrospective study to evaluate the effects on postoperative pulmonary function of pleural integrity versus opened pleura, in patients who receive a left internal mammary artery graft. The study group consisted of 1141 patients who underwent elective coronary artery bypass grafting. The patients were retrospectively evaluated and divided into 2 groups: those who underwent internal mammary artery harvesting with opened pleura (n=873) or with pleural integrity (n=268). To monitor pleural effusion and atelectasis, chest radiography was performed routinely 1 day before operation and on the 2nd, 5th, and 7th postoperative days. The preoperative, after extubation, and 1st postoperative day values of partial oxygen pressure (PaO2), partial carbon dioxide pressure (PaCO2), and oxygen (O2) saturation were recorded for comparison, as was the hematocrit. The mean age of the patients was 574 +/- 8.81 years. There were no significant differences between the groups in mean values of PaO2, PaCO2, O2 saturation, and hematocrit after extubation or on the 1st postoperative day. Atelectasis on the 5th and 7th postoperative days, pleural effusion on the 2nd, 5th, and 7th days, and postoperative bleeding were significantly less in the group with preserved pleural integrity. We showed that preservation of pleural integrity during internal mammary artery harvesting decreases postoperative bleeding, pleural effusion, and atelectasis. We conclude that preservation of pleural integrity, when possible, can decrease these postoperative complications of coronary artery bypass grafting.
authors.affiliation: The Department of Cardiovascular Surgery, Ege University, Izmir, Turkey. hikmetiyem@gmail.com
authors.forename: Hikmet
authors.initials: H
authors.lastname: Iyem
authors.forename: Fatih
authors.initials: F
authors.lastname: Islamoglu
authors.forename: Tahir
authors.initials: T
authors.lastname: Yagdi
authors.forename: Murat
authors.initials: M
authors.lastname: Sargin
authors.forename: Ozbek
authors.initials: O
authors.lastname: Berber
authors.forename: Ahmet
authors.initials: A
authors.lastname: Hamulu
authors.forename: Suat
authors.initials: S
authors.lastname: Buket
authors.forename: Isa
authors.initials: I
authors.lastname: Durmaz
mesh_terms: D000368:Aged; D005260:Female; D006400:Hematocrit; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010313:Partial Pressure; D010994:Pleura / Q000601:surgery*; D010996:Pleural Effusion / Q000209:etiology* / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D001261:Pulmonary Atelectasis / Q000209:etiology* / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*