Effects of skeletonized versus pedicled internal thoracic artery grafts on free flow capacity during bypass

Abstract

The free flow of skeletonized ITA grafts was compared with that of pedicled ITA grafts. One hundred patients with coronary artery diseases underwent elective CABG. In the group I (n = 50), the left ITA was dissected using the skeletonization technique. In the group I (n = 50), the ITA was harvested as a pedicled graft. Free flow of the ITA was recorded before and 15 min after intraluminal application of diluted papaverine. Mean arterial pressure was maintained at 9. 31 kPa (70 mmHg). The results showed that before the application of papaverine, free flow of skeletonized and pedicled ITA grafts was identical between the two groups. After treatment with papaverine, the maximum free flow was significantly higher in the skeletonized ITA’s in the group I (199. 3 ± 69. 6 ml/min) than in the group I (145. 7 ± 70. 3 ml/min,P < 0. 05). There was on significant difference between the free flow after dilatation of the left and right ITA in the group I (left 199. 3 ± 69. 6 ml/min, right 198. 9 ± 61. 8 ml/min, respectively). It was concluded that preparation of the ITA with the skeletonization technique resulted in significantly higher free flow capacity than in pedicled grafts and would improve the results of arterial revascularization. The complication rate seems to be lower than with the conventional method.

Keywords

coronary surgery / internal thoracic artery / skeletonization / vessel preparation technique

References

[1] FavaloroR G. Saphenous vein graft in the surgical treatment of coronary artery disease: operative technique. J Thorac Cardiovasc Surg, 1969, 58: 178-178

[2] KolessovV I. Mammary artery-coronary artery anastomosis as a method of treatment for angina pectoris. J Thorac Cardiovasc Surg, 1967, 54: 535-535

[3] BourassaM G, FisherL D, CampeauL, et al.. Long-term fate of bypass grafts: the Coronary Artery Surgery Study (CASS) and Montreal Heart Institute experiences. Circulation, 1985, 72(5): 71-71

[4] FioreA C, NaunheimK S, DeanP, et al.. Results of internal thoracic artery grafting over 15 years: single versus double grafts. Ann Thorac Surg, 1990, 49: 202-202

[5] GalbutD L, TraadE A, DormanM J, et al.. Seventeenyear experience with bilateral; internal mammary artery grafts. Ann Thorac Surg, 1990, 49: 195-195

[6] CameronA, DavisK B, GreenG, et al.. Coronary bypass surgery with internal-thoracic-artery grafts-effects on survival over a 15-year period. N Eng1 J Med, 1996, 334: 216-216

[7] BicalO, BraunbergerE, FischerM, et al.. Bilateral skeletonized mammary artery grafting: experience with 560 consecutive patients. Eur J Cardiothorac Surg, 1996, 10: 971-971

[8] CalafioreA M, DiGiammarco G, LucianiN, et al.. Composite arterial conduits for a wider arterial myocardial revascularization. Ann Thorac Surg, 1994, 58: 185-185

[9] KeeleyS B. The skeletonized internal mammary artery. Ann Thorac Surg, 1987, 44: 324-324

[10] CunninghamJ M, MohammadA G, FardinR, et al.. Considerations in the skeletonization technique of internal thoracic artery dissection. Ann Thorac Surg, 1992, 54: 947-947

[11] TectorA J, AmundsenS, SchmahlT M, et al.. Total revascularization with T-grafts. Ann Thorac Surg, 1994, 57: 33-33

[12] KouchoukosN T, WareingT H, MurphyS F, et al.. Risks of bilateral mammary artery bypass grafting. Ann Thorac Surg, 1990, 49: 210-210

[13] SeyferA E, ShriverC D, MillerTR, et al.. Sternal blood flow after median sternotomy and mobilization of the internal mammary arteries. Surgery, 1988, 104(5): 900-900

[14] GrossiE A, EspositoR, HarrisL J, et al.. Sternal wound infections and use of internal mammary artery grafts. J Thorac Cardiovase Surg, 1991, 102: 342-342

[15] HeG W, RyanW H, AcuffT E, et al.. Risk factors for operative mortality and sternal wound infection in bilateral mammary artery grafting. J Thorac Cardiovasc Surg, 1994, 107: 196-196

[16] JonesE L, LattoufA M, WeintraubW S. Catastrophic consequences of the internal mammary artery hypoperfusion. J Thorac Cardiovasc Surg, 1989, 98: 902-902

[17] De JesusR A, AclandR D. Anatomic study of the collateral blood supply of the sternum. Ann Thorac Surg, 1995, 59: 163-163

[18] MillsN L, BringazeW L. Preparation of the internal mammary graft. J Thorac Cardiovasc Surg, 1989, 98: 73-73

[19] DregelidE, HeldalK, ReschF, et al.. Dilatation of the internal mammary artery by external and intraluminal papaverine application. J Thorac Cardiovasc Surg, 1995, 110(3): 697-697

[20] NoeraG, PensaP, LodiR, et al.. Influence of different harvesting techniques on the arterial wall of the internal mammary artery graft: microscopic analysis. Thorac Cardiovasc Surgeon, 1993, 41: 16-16

[21] HillierC, WattP A C, SpytT J, et al.. Contraction and relaxation of human internal mammary artery after intraluminal administration of papaverine. Ann Throac Surg, 1992, 53: 1033-1033

[22] ChoiJ B, LeeS Y. Skeletonized and pedicled internal thoracic artery grafts: effects on free flow during bypass. Ann Thorac Surg, 1996, 61: 909-909