The skeletonization technique of left internal artery (LIMA) harvesting is reported as more spar-ing to the vascular supply of the sternum. Some studies report a greater length and greater flow of the graft additionally. The aim of our study was to measure the difference in post-op sternal blood supply compared to the pedicle harvesting technique and to measure the length and flow of the LIMA graft.
A total of 90 patients were examined in a prospective randomized study. In 60 patients referred for coronary artery bypass grafting (CABG), LIMA was harvested, one-half (n=30) skeletonized, and one-half (n=30) with a pedicle. Thirty patients operated via sternotomy without LIMA harvesting (other procedures, for instance, valve surgery) were the control group. In patients undergoing LIMA harvest, harvest duration, graft length, and graft free flow were measured at defined arterial pressure. In all patients, the sternal blood flow was examined by active dynamic thermography (DIRT): first preoperatively and on 4th postoperative day. During this, the time of spontaneous rewarming of the skin surface after the application of a cold stimulus was measured in the caudal part of the sternum. The difference between postoperative and preoperative time was calculated and compared between groups.
Study Type
OBSERVATIONAL
Enrollment
90
The mammary artery harvesting by the pedicle technique was used in the LIMA pedicle study group.
The mammary harvesting using the skeletonization technique was used in the LIMA skeletonized study group.
No intervention was used in the control study group.
University Hospital Ostrava
Ostrava, Moravial-Silesian Region, Czechia
Rewarming time difference
Duration of spontaneous rewarming of the skin surface of the caudal sternum after a cold stimulus, measured from 24°C to 27°C. Unit: seconds (s)
Time frame: first preoperatively and on 4th postoperative day
Duration of the mammary graft harvesting
Time from the start of the harvesting to complete graft release. Unit: minute (min).
Time frame: during surgery, immediately after the graft harvesting
Length of the mammary artery graft
Length from the distance of the graft from the chest wall to its distal end. Unit: millimeter (mm).
Time frame: during surgery, immediately after the graft harvesting
Free outflow of the mammary artery
After trimming the distal clip on the graft at an arterial pressure of 70 mmHg, free flow for 30 seconds, then multiplied by two. Unit: millilitre per minute (ml/min).
Time frame: during surgery, just before the graft use
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