Endothoracic injection of room air for internal mammary artery harvest.
BACKGROUND
Arterial spasm is described as an event occurring after internal mammary artery (IMA) harvesting. Endothoracic papaverine and carbon dioxide application have been used to prevent IMA spasm before surgical dissection. This technique may make harvest quicker and easier. The aim of this study is to evaluate the effect of room air injection into the endothoracic fascia on IMA blood flow and harvest time.


METHODS
Eighty-four consecutive ischemic patients were randomly assigned to four groups: group 1 (n = 21, no treatment), group 2 (n = 21, papaverine), group 3 (n = 21, air), group 4 (n = 21, air and papaverine). The room air was injected with a blunt needle through the endothoracic fascia before harvest. Each dissection time was recorded and the flows were measured before cardiopulmonary bypass.


RESULTS
Mean blood flows and harvest time were: group 1 = 65.7 +/- 16.3 mL/min, 37.2 +/- 8.5 minutes; group 2 = 86.6 +/- 16.4 mL/min, 25.6 +/- 5.5 minutes; group 3 = 85.7 +/- 13.1 mL/min, 22.4 +/- 4.8 minutes; and group 4 = 90.2 +/- 16.4 mL/min, 21.7 +/- 5.7 minutes. IMA flow and harvest time in groups 2, 3, and 4 were different than the control group (p < 0.001), but there was no significant statistical difference between treatment groups (2, 3, and 4) (p > 0.05).


CONCLUSIONS
Injection of room air beneath the endothoracic fascia before IMA dissection may prevent spasm and shorten harvest time, which avoids any risk of intimal injury.
Department of Cardiovascular Surgery, Osmangazi University Medical School and Research Hospital, Eskişehir, Turkey. ybesogul@gmail.com
Yavuz
Y
Beşoğul
D000388:Air; D001026:Coronary Artery Bypass / Q000379:methods*; D005205:Fascia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007432:Intraoperative Period; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D035423:Thoracic Cavity; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome