Hospital outcome analysis after different techniques of left internal mammary grafts harvesting.
BACKGROUND
Although accepted worldwide as the first-choice conduit for myocardial revascularization (coronary artery bypass graft surgery), it is still questionable if left internal mammary arteries (LIMAs) do better as pedicled or skeletonized grafts. Recent reports have suggested that the skeletonized technique improves the outcomes.


METHODS
In all, 516 consecutive isolated coronary artery bypass graft surgery patients admitted between January 2003 and February 2007 were grouped according to the harvesting technique of LIMAs (387 pedicled versus 129 skeletonized). Intraoperative transit time flow results, hospital outcome, perioperative troponin I leakage, and echocardiographic results were analyzed. Maximum, mean, and minimum flows, pulsatility index, and graft flow reserve were stratified according to the type of surgery (on pump and off pump) and subgroups at risk (severe left ventricular hypertrophy).


RESULTS
The transit time flow results were unsatisfactory in 4 patients (0.8%), all 4 of whom underwent redo anastomosis. Maximum, mean, and minimum flows and pulsatility index values were comparable between skeletonized and pedicled LIMAs (p = not significant), for both on-pump and off-pump surgeries (p = not significant). Graft flow reserve was comparable between the two groups (p = not significant), as well as transit time flow results in severe ventricular hypertrophy. Troponin leakage, postoperative echocardiographic recovery, and hospital outcome were comparable between the two groups (p = not significant at all time points). Only superficial wound complications proved higher in the pedicled group (2.6% versus skeletonized group: 0%; p = 0.05).


CONCLUSIONS
Pedicled LIMA carries a higher risk for minor wound complications. Neverthless, the two techniques showed similar in-vivo functional behavior and hospital outcome. Therefore, there is no reason to prefer one technique over the other.
Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Naples, Italy. frankono@libero.it
Francesco
F
Onorati
Antonio
A
Esposito
Francesco
F
Pezzo
Antonio
A
di Virgilio
Pasquale
P
Mastroroberto
Attilio
A
Renzulli
D000368:Aged; D003326:Coronary Circulation; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D019210:Troponin I / Q000378:metabolism
D019210:Troponin I