Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery (original) (raw)
Related papers
Coronary Revascularization Using Bilateral Internal Thoracic Arteries: Safe with Skeletonization?
Journal of Clinical & Experimental Cardiology, 2013
Substantial evidence exists to support a long-term survival benefit with bilateral internal thoracic artery (BITA) revascularization in coronary artery bypass grafting. However, this technique remains grossly underutilized worldwide and especially in the United States. In this review, we discuss evidence for the advantages of BITA grafting as well as the associated the risk of sternal wound complications. We then review a growing body of literature that suggests 'skeletonization' of the internal thoracic artery during harvest confers a protective benefit against sternal wound infection in patients receiving BITA.
International journal of surgery (London, England), 2014
It is suggested that the skeletonization harvesting technique influences the patency rates of internal thoracic artery (ITA) after coronary artery bypass graft (CABG) surgery in comparison to conventional (pedicled) harvesting. We conducted a meta-analysis to determine whether there is any difference between skeletonized versus pedicled ITA in terms of patency after CABG. We performed a systematic-review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that performed angiographic evaluation within the first two years after CABG between these two groups until December 2013. The principal summary measures were odds ratio (OR) with 95% Confidence Interval (CI) and P values (statistically significant when <0.05). The OR's were combined across studies using weighted DerSimonian-Laird random effects model and weighted Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and meta-regressi...
InterAmerican Journal of Medicine and Health, 2020
Objective: To compare the postoperative bleeding between the skeletonized grafts and pedicled internal thoracic artery (ITA) in coronary artery bypass. Material and Method: 132 elective patients submitted to the surgery of myocardial revascularization were retrospectively analyzed and the sample was equally distributed in groups according to the dissection performed on the ITA: G1, skeletonized and G2, pedicled. In both methods, the dissection was finished before the heparinization and the installation of extracorporeal circulation. The following clinical parameters were evaluated: extracorporeal circulation time, aortic clamping, drainage debit and administration of hemocomponents (erythrocytes and platelets). Results: The average number of platelets concentrations and the drainage debit on the postoperative period were statistically higher for the pedicled dissection of the ITA compared to the skeletonized one. No statistically significant differences were observed regarding the...
European Journal of Cardio-Thoracic Surgery, 1999
Objective: The internal thoracic artery (ITA) is the ideal conduit for coronary artery bypass grafting (CABG). The skeletonization technique of this arterial conduit has been proposed to reduce chest wall trauma, increase graft length and facilitate construction of sequential anastomoses. Nevertheless, some surgeons decline this technique because of potentially increased trauma to the ITA with impairment of flow. In this investigation we compared the free flow of skeletonized with that of pedicled ITA grafts. Methods: Two surgeons operated on 80 consecutive patients with coronary artery disease for elective CABG. In group I (n = 40), the left ITA was dissected using the skeletonization technique. In group II (n = 40), it was harvested as a pedicled graft. In 23 patients of group I both ITA's were dissected in skeletonized fashion for complete arterial revascularization. Diluted papaverine was instilled into the lumen of the ITA after distal transection of the vessel in both groups. Free flow of the ITA was registered before and 15 min after intraluminal application of diluted papaverine. Mean arterial pressure was maintained at 70 mmHg. Results: Before the application of papaverine, free flow of skeletonized and pedicled ITA grafts was identical between the two groups. After treatment with papaverine maximum free flow was significantly higher in the skeletonized ITA's (group I 197.2 (±66.6) ml/min; group II 147.1 (±70.5) ml/min; P Ͻ 0.05). There was no significant difference between free flow after dilatation of the left and right ITA in group I (left 197.2 (±66.6) ml/min; right 198.9 (±61.8) ml/min). Conclusions: Preparation of the ITA with the skeletonization technique results in significantly, higher free flow capacity than in pedicled grafts. This may increase the safety of arterial revascularization by reducing the risk of ITA hypoperfusion syndrome.
The Annals of Thoracic Surgery, 2011
Background-Observational studies suggest that skeletonization of the internal thoracic artery (ITA) can improve conduit flow and length and reduce deep sternal infections and postoperative pain. We performed a randomized, double-blind, within-patient comparison of skeletonized and nonskeletonized ITAs in patients undergoing coronary surgery. Methods and Results-Patients (nϭ48) undergoing bilateral ITA harvest were randomized to receive 1 skeletonized and 1 nonskeletonized ITA. Intraoperatively, ITA flow was assessed directly and with a Doppler flow probe before and after topical application of papaverine. ITA harvest time and conduit length were recorded. A blinded assessment of pain (visual analog scale) and dysesthesia (physical examination) was performed at discharge, at 2 weeks, and at a 3-month follow-up. Sternal perfusion was assessed with nuclear imaging (nϭ7). Skeletonization required longer ITA harvest times (27Ϯ1 versus 24Ϯ1 minutes; Pϭ0.04). There was a trend toward increased ITA length in the skeletonized group (18.2Ϯ0.3 versus 17.7Ϯ0.3 cm; Pϭ0.09). In situ ITA flow was lower in skeletonized arteries (7.4Ϯ0.9 versus 10.1Ϯ1.0 mL/min; P)10.0؍ and increased significantly after ITA division and papaverine application. Postanastomotic flows were similar between groups. Skeletonization was associated with decreased pain at the 3-month follow-up and a reduction in major sensory deficits at the 4-week and 3-month (17% versus 50%; Pϭ0.002) follow-ups. Baseline adjusted sternal perfusion was significantly greater by 17Ϯ6% (Pϭ0.03) on the skeletonized side.
Skeletonized radial artery grafting: improved angiographic results
The Annals of Thoracic Surgery, 2002
Background. The radial artery has been used for coronary artery bypass grafting (CABG) but its early angiographic results were relatively inferior to that of the internal mammary artery, most likely due to spasm of the graft. To avoid vasospasm we harvested the radial artery using a skeletonized technique and spasm was completely reversed before use. The graft patency of the skeletonized radial artery was compared with the radial artery graft harvested as a pedicle.
Changing pattern in beating heart operations: use of skeletonized internal thoracic artery
The Annals of Thoracic Surgery, 2002
Background. The use of skeletonized internal thoracic artery (ITA) was reported to be technically and hemodynamically beneficial in conventional coronary artery bypass grafting with cardiopulmonary bypass assistance. The purpose of this study is to evaluate the impact of changing from conventional to skeletonized ITA harvesting on early off-pump coronary artery bypass grafting outcome. Methods. Between 1996 and 2001, 640 patients underwent systematic off-pump coronary artery bypass grafting (single surgeon experience). The ITA was pedicled (P) in the first consecutive 440 patients and skeletonized (S) in the subsequent 200 consecutive patients. Mean age, preoperative risk factors, sex, number of involved territories, and incidence of reoperations were similar in both groups. Results. In group S, number of ITAs per patient (1.7 ؎ 0.08 versus 1.2 ؎ 0.05; p < 0.001), bilateral ITA (46% versus 27%; p < 0.001), ITA sequential grafts (27% versus 1%; p < 0.001), and T grafts (16% versus 3%; p < 0.001) were higher. Deep sternal infections were comparable in both groups (group S: 1%, group P: 1.2%; p ؍ 0.38). Perioperative myocardial infarction, maximal creatinine kinase-MB level, and requirement for more than 24 hours of inotropic support were comparable in both groups. Thirty-day mortality was also similar (S: 1.7%, P: 1.6%). Conclusions. Changing to routine use of skeletonized ITA in off-pump coronary artery bypass grafting is a safe alternative to routine pedicled ITA. In our experience, this procedure has facilitated the use of ITA anastomosis without increasing sternal wound complications.