The effects of internal thoracic artery preparation with intact pleura on respiratory function and patients' early outcomes.
OBJECTIVE
Postoperative respiratory functions, arterial blood gases, blood loss and clinical outcome following coronary artery bypass surgery (CABG) were assessed in a prospective randomized single-blind (patient- blind) clinical study comparing two different techniques of internal thoracic artery (ITA) harvesting.


METHODS
Fifty-four patients admitted for CABG were allocated into two groups according to 'random numbers' technique. In a Group 1 (n=26) ITA was prepared keeping the pleura intact and in a Group 2 (n=28) pleura was opened. Both groups were compared in terms of postoperative respiratory functions, arterial blood gases, bleeding and clinical outcomes using ANOVA for repeated measurements analysis.


RESULTS
Analysis of spirometric and partial oxygen pressure data showed that postoperative reductions in forced expiratory volume (0.17+/-0.18 lt vs. 0.28+/-0.14 lt, p=0.016), forced vital capacity (0.18+/-0.19 lt vs. 0.28+/-0.13 lt, p=0.037) and arterial oxygen measurements (-0.03+/-0.22 mmHg vs. 0.15+/-0.4 mmHg, p=0.023) were less pronounced in patients of Group 1 as compared with patients of Group 2. The increase in intrapulmonary shunts (Qs/Qt ratio) after the operation was more pronounced in Group 2 patients than in Group 1 patients (p<0.01) and the mean values of Qs/Qt ratio 24 hours after the operation were higher in group 2 as compared to Group 1 patients(0.100+/-0.063 vs. 0.054+/-0.048, p=0.001). Radiological evaluation revealed that costophrenic angle obliteration after operation more often occurred in Group 2 (14/28 patients) than in Group 1 (0/26 patients) (p<0.0001). Cardiothoracic index increased significantly after operation only in group 2 patients (p=0.001). Postoperative blood loss within 24 hours was significantly lower in Group 1 compared to Group 2 (656+/-179 ml vs. 907+/-257 ml, p=0.001). There was no significant difference between groups in the ICU stay duration (p=0.186), whereas the hospital stay was significantly longer in group 2 patients than in Group 1 patients (8.8+/-2.0 days vs. 7.6+/-2.0 days, p=0.039).


CONCLUSIONS
According to our results, preserving pleural integrity has positive effects on the respiratory functions and patients' clinical outcomes following CABG operations.
Ozkara
Ahmet
A
Department of Cardiovascular Surgery, School of Medicine, Istanbul Bilim University, Istanbul, Turkey. aozkara@superonline.com
Hatemi
Alican
A
Mert
Murat
M
Köner
Ozge
O
Cetin
Gürkan
G
Gürsoy
Mete
M
Celebi
Serdar
S
Erdem
Can Cağlar
CC
Haydin
Sertaç
S
Yildiz
Cenk Eray
CE
Süzer
Kaya
K
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000502:physiology / Q000503:physiopathology; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D012129:Respiratory Function Tests; D016037:Single-Blind Method; D013147:Spirometry; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D014797:Vital Capacity
D010100:Oxygen