Changing pattern in beating heart operations: use of skeletonized internal thoracic artery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery

Background:

• Skeletonized internal thoracic artery (ITA) harvesting offers technical and hemodynamic benefits in conventional coronary artery bypass grafting (CABG).
• Previous studies suggest advantages of skeletonized ITA in on-pump procedures.
• The impact on off-pump CABG outcomes requires further evaluation.

Purpose of the Study:

• To assess the early outcomes of transitioning from pedicled to skeletonized ITA harvesting in off-pump coronary artery bypass grafting (OPCABG).
• To compare the safety and efficacy of skeletonized versus pedicled ITA harvesting in OPCABG.

Main Methods:

• A retrospective analysis of 640 patients undergoing OPCABG by a single surgeon between 1996 and 2001.
• Patients were divided into two groups: pedicled ITA harvesting (P, n=440) and skeletonized ITA harvesting (S, n=200).
• Baseline characteristics, graft utilization, and early postoperative outcomes were compared.

Main Results:

• Group S demonstrated significantly higher rates of bilateral ITA use (46% vs. 27%), ITA sequential grafts (27% vs. 1%), and T grafts (16% vs. 3%) compared to Group P.
• Deep sternal infections were comparable between groups (1% in S vs. 1.2% in P).
• Perioperative myocardial infarction, peak creatine kinase-MB levels, inotropic support duration, and 30-day mortality were similar in both groups.

Conclusions:

• Routine skeletonized ITA harvesting is a safe and viable alternative to pedicled ITA harvesting in OPCABG.
• This technique facilitates increased ITA graft utilization without compromising sternal wound integrity.
• Skeletonized ITA harvesting in OPCABG is associated with comparable early clinical outcomes.