Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura

Bonacchi, Massimo; Prifti, Edvin; Giunti, Guido; Salica, Andrea; Frati, Giacomo; Sani, Guido

doi:10.1016/s1010-7940(01)00695-9

Cited by 79 publications

(73 citation statements)

References 19 publications

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“…All the IMAs in this study were harvested with a skeletonized technique, which has been demonstrated to better preserve sternal blood flow [23][24][25] and to reduce the risk of SWI. 26,27 Similarly, early reports of increased postoperative bleeding 28 and pulmonary morbidity 29 with BIMA grafting have not been substantiated by subsequent studies 30,31 and were not evident in the present study.…”

Section: Discussioncontrasting

confidence: 72%

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

et al. 2012

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Background— The prevalence of diabetes mellitus is increasing at an unprecedented rate, affecting nearly 8% of the population. Previous studies have demonstrated a potential benefit for surgical over interventional revascularization in this group of patients. Similarly, studies have shown the superiority of bilateral internal mammary artery (BIMA) grafting over single internal mammary artery (SIMA) grafting in select populations. However, concerns about sternal wound infection have discouraged the use of BIMA grafting in diabetics. Therefore, we studied the long-term results of BIMA versus SIMA grafting in a large population of diabetic patients in whom BIMA grafting was broadly applied. Methods and Results— Between February 1972 and May 1994, 1107 consecutive diabetic patients underwent coronary artery bypass grafting with either SIMA (n=646) or BIMA (n=461) grafting. Optimal matching with the propensity score was used to create matched SIMA (n=414) and BIMA (n=414) cohorts. Cross-sectional follow-up (6 weeks to 30.1 years; mean, 8.9 years) determined long-term survival. There was no difference in operative mortality, sternal wound infection, or total complications between matched SIMA and BIMA groups (operative mortality, 10 of 414 [2.4%] versus 13 of 414 [3.1%]; P =0.279; sternal wound infection, 7 of 414 [1.7%] versus 13 of 414 [3.1%]; P =0.179); total complications, 71 of 414 [17.1%] versus 71 of 414 [17.1%]; P =1.000). Late survival was significantly enhanced with the use of BIMA grafting (median survival: SIMA, 9.8 years versus BIMA, 13.1 years; P =0.001). Use of BIMA was found to be associated with late survival on Cox regression ( P =0.003). Conclusion— Compared with SIMA grafting, BIMA grafting in propensity score–matched patients provides diabetics with enhanced survival without any increase in perioperative morbidity or mortality.

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Section: Discussioncontrasting

confidence: 72%

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

et al. 2012

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“…Çalışmada ayrıca 21 hastaya plevral drenaj için ilave girişim (torasentez, göğüs tüpü yerleştirilmesi, reeksplorasyon) gerektiği ifade edilmiş-tir. Bonacchi ve ark., [9] plevra açılarak İMA çıkarılan hastalarda tek taraflı plevral efüzyon ve torasentez insidansının daha yüksek olduğunu bildirmişlerdir. Tulla ve ark.…”

Section: Discussionunclassified

Management of pleural effusions developing after open heart surgery

Yıldırım¹

2013

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada açık kalp cerrahisi sonrası gelişen plevral efüzyonlara karşı tedavi yaklaşımlarımız değer-lendirildi. Ça lış ma pla nı: Ocak 2011 -Aralık 2011 tarihleri arasında açık kalp cerrahisi sonrası plevral efüzyon gelişen 35 hastada (27 erkek, 8 kadın; ort. yaş 61.1 yıl; dağılım 25-79 yıl) göğüs cerrahisi kliniğinde uygulanan yaklaşımlar prospektif olarak incelendi. Tedavi yaklaşımları-nın klinik sonuçları; yaş, cinsiyet, önceki ameliyat tipi, önceki ameliyat ile göğüs cerrahisi girişimi arasında geçen zaman, yeri, drenaj vasfı, ekokardiyografi bulguları, uygulanan işlem tipi, komplikasyon ve mortalite yönünden incelendi. Bul gu lar: Otuz beş hasta 51 kez göğüs cerrahisi kliniğinde yatırıldı ve bu hastalara toplamda 62 işlem uygulandı. Yirmi hastada sol taraflı, 12 hastada sağ taraflı ve üç hastada iki taraflı plevral efüzyon saptandı. Efüzyonların toplam %59.67'si seröz karakterli idi. Toplam 62 işlemin 43'ü (%69.35) torasentez idi. Üç hastaya video yardımlı torakoskopik cerrahi (VYTC) yapılır iken, dört hastaya torakotomi yapıldı. Beş işlemde komplikasyon ve iki işlemde mortalite gözlendi. So nuç: Açık kalp cerrahisi sonrası görülen plevral efüzyonlar, özellikle aortokoroner baypas ameliyatı sırasında sol ön inen arter -sol iç meme arteri anastomozu yapılan ve sol plevraları cerrahi teknik nedeni ile açılmış olgularda gelişebilir. Hastalığın semptomları ve bulguları ihmal edilir veya göğüs cerrahi konsültasyonu geciktirilirse, dekortikasyon gibi invaziv bir yöntem ihtiyacı olabilir.Anah tar söz cük ler: Açık kalp cerrahisi; plevral hastalıklar; plevral efüzyon. Background:In this study, we aimed to evaluate our management approaches to pleural effusions which developed after open heart surgery. Methods: Between January 2011 and December 2011, thoracic surgical approaches to 35 patients (27 males, 8 females; mean age 61.1 years; range 25 to 79 years) whom developed pleural effusion after open heart surgery were prospectively analyzed. The clinical outcomes of management approaches, were evaluated in terms of age, gender, previous operation type, time from previous operation to thoracic surgical intervention, localization, character of drainage, echocardiographic findings, type of procedure applied, complications and mortality. Results: Thirty-five patients were hospitalized 51 times in thoracic surgery clinic and 62 procedures were applied. Twenty patients had left-sided, 12 patients had rightsided and three patients had bilateral pleural effusions. A total of 59.67% of effusions were serous in character. Of 62 procedures, 43 (69.35%) were thoracentesis. Videoassisted thoracoscopic surgery (VATS) was applied in three patients, while thoracotomy was performed on four patients. Complications were observed in five procedures and mortality was observed in two procedures. Conclusion: Pleural effusions which develop after open heart surgery may occur in patients particularly undergoing left anterior descending -left internal mammary artery anastomosis during aortocoronary bypass surgery in which left pleu...

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“…Second, skeletonization improves blood supply to the sternum (measured by single photon emission computed tomography) [16] compared with pedicled harvesting. Third, skeletonization decreases the incidence of postoperative respiratory dysfunction because of less invasive harvesting (i.e., preserved pleural integrity in skeletonized ITA vs. pleurotomy in pedicled ITA) [17,18]. Lastly, skeletonization markedly reduces anterior chest pain and dysesthesia 3 months after surgery [19].…”

Section: Discussionmentioning

confidence: 99%

Both skeletonized and pedicled internal thoracic arteries supply adequate graft flow after coronary artery bypass grafting even during intense sympathoexcitation

et al. 2010

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The internal thoracic artery (ITA) is harvested by either the pedicled or the skeletonized technique in coronary artery bypass grafting (CABG), with no clear advantage of one technique over the other. We compared graft flow between the pedicled and skeletonized ITA grafts while varying myocardial oxygen demand. CABG was performed to the left anterior descending artery in five anesthetized dogs using a pedicled ITA graft and the graft was subsequently skeletonized. Graft flow was measured during stepwise electrical stimulation of the stellate ganglion. The baseline graft flow before sympathetic stimulation was higher in skeletonized (27.8 ± 1.9 ml/min) than that in pedicled ITA grafts (22.6 ± 2.7 ml/min) (P < 0.05). In both ITA grafts, however, graft flow increased to a similar level during sympathetic stimulation that doubled the double product, correlating with the double product. Based on these results, we conclude that metabolic demand can override the potential difference in sympathetic vasoconstriction in both pedicled and skeletonized ITA grafts.

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Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura

Cited by 79 publications

References 19 publications

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

Management of pleural effusions developing after open heart surgery

Both skeletonized and pedicled internal thoracic arteries supply adequate graft flow after coronary artery bypass grafting even during intense sympathoexcitation

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