title: Assessment of the Impact of Skeletonization on Pleuropulmonary Changes after Bilateral Internal Thoracic Artery Harvest for Coronary Artery Bypass Grafting.
abstract: OBJECTIVE
  Skeletonization has been proposed as a technique to minimize the risk of sternal devascularization during bilateral internal thoracic artery harvest for coronary artery bypass grafting. The impact of this strategy on late radiologic pleuropulmonary changes has not been addressed.
  
  
  METHODS
  Post-operative chest radiographs from patients (n = 253 per group) undergoing bilateral internal thoracic artery harvest using skeletonized and non-skeletonized techniques were reviewed by blinded radiologists. The primary outcome was the incidence of atelectasis and pleural effusion. Multivariable linear regression models were derived to assess the relationship of radiologic pleuropulmonary outcomes to patients and operative variables.
  
  
  CONCLUSIONS
  Patients in the skeletonized group were older (p < 0.0001), had a lower preoperative hematocrit (p = 0.014), had higher prevalence of peripheral vascular disease (p = 0.001), were of female gender (p = 0.015), underwent off-pump surgery (p < 0.001), had urgent/emergent status (p = 0.024), and had chronic obstructive pulmonary disease (p = 0.019). There was no difference in the incidence of post-operative complications, ventilation time, or intensive care unit stay. There was no difference in the severity of post-operative atelectasis in both groups. More patients in the non-skeletonized group had a grade 2/3 left pleural effusion on the late post-operative chest X-ray (p = 0.007). The independent effect of skeletonization on the development of a late left pleural effusion was significant (odds ratio = 0.558, 95% confidence interval = 0.359-0.866, p = 0.009). Skeletonization results in a decreased incidence of late post-operative left pleural effusion with no difference in early or late atelectasis. Further studies are warranted to assess the mechanism of these pleuropulmonary changes and the impact of other factors such as pleural violation during surgery.
authors.affiliation: Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada.
authors.forename: C J
authors.initials: CJ
authors.lastname: Dennie
authors.affiliation: Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Oikonomou
authors.affiliation: Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Thornhill
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada frubens@ottawaheart.ca.
authors.forename: F D
authors.initials: FD
authors.lastname: Rubens
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Coronary artery disease; atelectasis; open heart surgery; pleural effusion; radiology-thoracic