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Decreased sternal vascularity after internal thoracic artery harvesting resolves with time: an assessment with single
Benjamin Medalion1, Michael G Katz, Mordechai Lorberboym
1Departments of Cardiovascular Surgery and Nuclear Medicine, The Edith Wolfson Medical Center, Holon, 58100 Israel. medalion@wolfson.health.gov.il
Insights
Harvesting the left internal thoracic artery for coronary artery bypass grafting temporarily reduces sternal blood flow. However, sternal vascularity returns to normal levels within months, indicating a transient effect.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- The left internal thoracic artery (LITA) is a crucial graft in coronary artery bypass grafting (CABG).
- Concerns exist regarding the impact of LITA harvesting on sternal blood supply and healing.
Purpose of the Study:
- To prospectively assess the long-term effects of LITA harvesting on sternal vascularity.
- To evaluate the temporal changes in sternal blood flow after LITA pedicled harvesting.
Main Methods:
- Prospective study of 12 patients undergoing primary CABG with LITA harvesting.
- Technetium-99m methylene diphosphonate bone scans with SPECT were performed preoperatively, early postoperatively, and at late follow-up (18.6 months).
- Ratios of sternal uptake were analyzed to quantify blood flow changes.
Main Results:
- A significant decrease in left hemisternum blood flow was observed in the early postoperative period (P <.001).
- Sternal blood flow in the left hemisternum normalized by the late follow-up scan (P =.119).
- Three superficial wound infections occurred; no musculoskeletal pain was reported, though some patients experienced localized numbness/tingling.
Conclusions:
- Harvesting a pedicled LITA causes temporary acute postoperative sternal ischemia.
- Sternal vascularity recovers over time, suggesting LITA harvesting is safe concerning long-term sternal blood supply.
Objective:
We sought to prospectively evaluate the long-term effect of left internal thoracic artery harvesting on sternal vascularity.
Methods:
Twelve consecutive patients undergoing primary coronary artery bypass grafting were studied. In all patients a pedicled left internal thoracic artery was harvested. Each patient underwent a preoperative technetium-99m methylene diphosphonate bone scan with single photon emission computed tomography. The ratio of the mean counts per pixel for each side of the sternum was obtained. All patients had early repeat bone scans 6 plus minus 2.4 days postoperatively and late repeat bone scans 18.6 plus minus 3.5 months after the operation. Ratios of unilateral sternal uptakes were compared between the different scans. One patient died during follow-up and was excluded from the study.
Results:
There was a significant decrease in flow to the left hemisternum in the early postoperative scan compared with that in the preoperative scan (P <.001). At late follow-up scans, flow to the left hemisternum had returned to normal (P =.119). Midterm clinical follow-up demonstrated 3 superficial wound infections. No musculoskeletal pain existed at the time of follow-up, but 3 patients had numbness or tingling at the skin area corresponding to the site from which the left internal thoracic artery was harvested.
Conclusions:
Acute postoperative sternal ischemia caused by harvesting of a pedicled left internal thoracic artery is temporary and resolves with time.