Abstract

Comparison of the Effect of Skeletonized and Pedicled Left Internal Thoracic Artery Harvesting Techniques in Coronary Artery Bypass Surgery

Author(s): Palanki Surya Satya Gopal1 , Sai Pavan Anne2 , Madhusudan Lal Kummari3 , Kaladhar Bomma4 , Amaresh Rao Malempati5

BACKGROUND We wanted to study the effect of 2 LIMA (Left Internal Mammary Artery) harvesting techniques (skeletonization and pedicled) on ITA’s (Internal Thoracic Arteries) flow, length, postoperative sternal wound infection and postoperative pain. METHODS This is a randomized controlled trial of the two different methods of internal mammary artery harvesting. The study was conducted in the Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences (NIMS) and included people undergoing coronary artery bypass grafting (CABG) over a period of 18 months from January 2016 to July 2017. RESULTS In study subjects, male participants were 28 (70 %). The mean flowrate of skeletonized group was 99.7 ± 5.03 and that of the pedicled group was 60.5 ± 3.97; the mean difference (39.2) between the two groups was statistically significant. The mean length of skeletonized group was 21.55 ± 2.26 and that of the pedicled group was 15.6 ± 2.39; the mean difference (5.95) between the two groups was statistically significant. In the skeletonized group, 1 (5 %) had no pain, 8 (40 %) had mild pain, 6 (30 %) had moderate pain, 4 (20 %) had severe pain, and 1 (5 %) had very severe pain. In the pedicled group, 6 (30 %) had mild pain, 6 (30 %) had moderate pain, 5 (25 %) had severe pain and 3 (15 %) had very severe pain. The difference in the proportion of postoperative sternal infections within the study group was statistically not significant. CONCLUSIONS Skeletonization technique has higher mean free flow (of the LIMA) and mean length (of the left internal thoracic artery graft) than that of pedicled technique.