Short Term Clinical and Angiographic Outcome of Skeletonized Harvesting Technique of Left Internal Mammary Artery, Compared to Pedicled Harvesting for Coronary Revascularization

Abstract

We examined the hypothesis that the short term clinical and angiographic outcome of skeletonized Left Internal Mammary Artery (LIMA) is better than that of pedicled LIMA used for revascularization of left anterior descending artery at CABG surgery at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute from May 2011 to April 2012. Accordingly we studied 60 consecutive patients who underwent coronary artery bypass grafting, in which the LIMA was anastomosed to the left anterior descending artery (LAD). In 30 consecutive LIMAs were harvested as a pedicle (Control Group) and another 30 consecutive LIMAs were harvested as skeletonized graft (Experimental Group). Three diameters of the LIMA graft were measured quantitatively in postoperative angiograms performed 6 ± 1 month after the coronary artery bypass grafting; D1, at the origin from the subclavian artery; D2, at the level of the second intercostal space; and D3, just proximal to the anastomosis. Our study shows that, complete skeletonization results in increased graft length 19.71 ± 1.77 cm in skeletonized group vs. 17.08 ± 0.71cm in pedicle group (p <0.001). Although there was similar incidence of superûcial wound complications between the groups, the post CABG pain (PCP) was significantly higher in pedicled group at the 6 month follow-up. Check coronary angiography showed the LIMA grafts to the LAD were all patent. There was increased diameter achievement in skeletonized group at the anastomotic site (D3: 1.78 ± 0.21 mm vs. 1.66 ± 0.18 mm; p = 0.03). We conclude that skeletonized LIMA showed a better functional behavior, giving longer conduit length and superior postoperative clinical and angiographic profile.

Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in Coronary Artery Bypass Surgery

“…Few studies have directly compared the results of pedicled and skeletonized harvesting techniques with regard to early graft occlusion after cardiac surgery. Except for a small trial of 200 patients, all other studies were nonrandomized and are from centers favoring the skeletonized over pedicled technique in their practice (two-thirds of patients received a skeletonized IMA over a pedicled IMA).…”

Systematic Review and Pooled Meta-analysis of the Current Status of Coronary Revascularization Surgery in Bangladesh

“…al 22,32 and Sazzad et. al, 18,27 all published in different years had been included in our meta-analysis as seen in Table 1. Assessment of the full texts verified that these studies were performed on completely different study populations, and were therefore included separately in our meta-analysis.…”

“…From our risk of bias assessment of the included studies, we determined that 2 randomized controlled trials were associated with high risk of performance bias due to the outcome assessors not being blinded to the type of intervention 12,. For the 14 prospective observational studies, 15,[18][19][20][21][22][23][24][25][26][27]30,31,35 there was high risk of bias in confounding factors. The non-ramdomized clinical trials 11,14,16,28,34 were also significantly biased due to absence of randomization.…”