Effects of internal mammary artery dissection on phrenic nerve perfusion and function

O’Brien, James; Johnson, Scott H.; VanSteyn, Scott J.; Craig, Damian M.; Sharpe, Robbin E.; Mauney, Michael C.; Smith, Peter K.

doi:10.1016/0003-4975(91)91334-r

Cited by 56 publications

(31 citation statements)

References 25 publications

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“…O'Brien et al (1991) reported that, in an adult swine model, 52% of its blood supply came from the pericardiacophrenic artery, and 21% from the cranial pleural and pericardial branches of the internal thoracic artery. According to Henriquez-Pino's investigation (1993), the pericardiacophrenic artery was a branch of the internal thoracic artery in 99% of cases, while in the rest it originated from the subclavian artery, which is basically in agreement with the results of the current study.…”

Section: Discussionmentioning

confidence: 98%

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

Shen

et al. 2011

Anat Sci Int

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For surgeries aimed at the dissection of full-length phrenic nerve, a full appreciation of its trajectory, blood supply and correlation with adjacent anatomical structures is necessary, especially for endoscopic manipulations. A fresh cadaver study was conducted with the purpose of avoiding surgical complications and ensuring further efficacy and efficiency of endoscopic manipulations. Ten fresh adult cadavers were dissected. Special attention was paid to the topography of the origin, the trajectory of the phrenic nerve, and its anatomic communication with the surrounding vessels and organs. In the second side of the cadavers, thoracic endoscopic manipulations and observations were also performed. The full length of the phrenic nerve was 24.6 ± 1.7 and 30.6 ± 1.8 cm on the right and left side, respectively; the blood supply of the phrenic nerve in the thoracic cavity came exclusively from the pericardiacophrenic artery; the distance between the origin of the pericardiacophrenic artery and that of the internal thoracic artery ranged from 0.5 to 5.2 cm on the right side, and from 1.4 to 5.6 cm on the left; most of the pericardiacophrenic veins intermingled with small vessels of pericardium and pleura, forming a venous network and joining the innominate vein. Endoscopic dissection of the thoracic phrenic nerve together with the accompanying pericardiacophrenic artery can be performed. Extreme attention should be paid during surgery to a section of about 6 cm in length of the artery originating from the internal thoracic artery, while the accompanying veins do not require to be spared.

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Section: Discussionmentioning

confidence: 98%

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

Shen

et al. 2011

Anat Sci Int

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“…As demonstrated in O'Brien and colleagues' study [3] , approximately 52 % of the left phrenic nerve blood supply is provided by the pericardiacophrenic artery, 21 % by pleura, pericardial, and diaphragmatic vessels originating from LIMA, and the remainder from alternate sources. By sparing the pericardiacophrenic artery, 73 % of the mammary artery contribution to phrenic nerve blood supply is preserved, with commensurate reduction in acute PNI.…”

Section: Mechanisms Of Phrenic Nerve Injurymentioning

confidence: 93%

“…Many factors have been implicated as contributing to an increased incidence of PNI, including the use of left internal mammary artery (LIMA) [1,2] , devascularization of the periphrenic nerve blood vessels [3] , surgical manipulation [2,4] , clod injury [5][6][7] , the low preoperative myocardial performance [1] , chronic obstructive pulmonary disease (COPD) [8] , diabetes [9,10] , increased age [11] , and patient variability.…”

mentioning

confidence: 99%

Semi-skeletonized internal mammary grafts and phrenic nerve injury: Cause-and-effect analysis

Deng

Sun

et al. 2006

J. Huazhong Univ. Sc. Technol.

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Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries (2.5%). There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery (Odds ratio (OR) = 14.5) and thepresence of chronic obstructive pulmonary disease (OR = 2.9). Phrenic nerve injury was an independent risk factor (OR = 8.1) for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself.

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“…Approximately 73% of the blood supply to phrenic nerve is by pericardiophrenic artery, 21% by pleural, pericardial and diaphragmatic branches of IMA and the remaining from alternate sources. 3 We carefully preserved the pericardiophrenic artery while harvesting IMA during inferomedial dissection in the proximal 4 cm of IMA pedicle near its origin to avoid ischemic phrenic nerve injury and none of our patients showed any evidence of coronary steal phenomenon after CABG.…”

Section: Discussionmentioning

confidence: 98%

Prevention of post operative phrenic nerve palsy in patients undergoing cardiac surgery

Puri

et al. 2001

Indian J Thorac Cardiovasc Surg

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Introduction. Close proximity of phrenic nerves to pericardium and internal mammary arteries (IMA) makes them liable to injury during cardiac surgery which occurs due to its transection, compromised vascularity or hypothermia.Methods. Between July, 1999 to August, 2000 fifty fresh cadavers were examined and the intrathoracic course of phrenic nerves was studied. This information was utilised while performing 200 open heart operations. Intermittent cooled saline (4~ was used instead of ice slush for topical cooling and pericardiophrenic branch of IMA was preserved while harvesting it.Results. Variations were observed in the anatomical relationship between the phrenic nerves and proximal internal mammary arteries. Incidence of unilateral phrenic nerve injury among patients who had open heart surgery was 1.5% and was 4% among patients in whom internal mammary artery was harvested.Conclusion. A thorough knowledge of anatomical variations in the course of phrenic nerves, preservation of pericardiophrenic branch of IMA while harvesting it for CABG and use of cooled saline instead of ice slush for topical cooling helps in avoiding phrenic nerve injury during cardiac surgery. (Ind J Thorac Cardiovasc Surg, 2001; 17: 225-229)

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Effects of internal mammary artery dissection on phrenic nerve perfusion and function

Cited by 56 publications

References 25 publications

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

Semi-skeletonized internal mammary grafts and phrenic nerve injury: Cause-and-effect analysis

Prevention of post operative phrenic nerve palsy in patients undergoing cardiac surgery

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