Effects of skeletonized versus pedicled internal thoracic artery grafts on free flow capacity during bypass

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Surgical Techniques

Background:

• Coronary artery bypass grafting (CABG) is a primary treatment for coronary artery disease.
• Internal thoracic artery (ITA) grafts are crucial for arterial revascularization.
• Optimizing graft quality, such as free flow, is essential for long-term patency and patient outcomes.

Purpose of the Study:

• To compare the free flow of skeletonized versus pedicled ITA grafts.
• To evaluate the impact of the skeletonization technique on ITA graft vascular capacity.
• To assess the potential benefits of skeletonized ITA grafts in improving CABG results.

Main Methods:

• A prospective study involving 100 patients undergoing elective CABG.
• Group I (n=50): Left ITA harvested using skeletonization technique.
• Group II (n=50): Left ITA harvested as a pedicled graft.
• Free flow measurements of ITA grafts before and after papaverine administration.
• Standardized mean arterial pressure maintained at 70 mmHg.

Main Results:

• Pre-papaverine, free flow was similar between skeletonized and pedicled ITA grafts.
• Post-papaverine, skeletonized ITA grafts demonstrated significantly higher free flow (199.3 ml/min) compared to pedicled grafts (145.7 ml/min, P < 0.05).
• No significant difference in free flow was observed between left and right ITA grafts prepared with skeletonization.

Conclusions:

• The skeletonization technique significantly increases the free flow capacity of ITA grafts compared to the pedicled method.
• Enhanced graft flow from skeletonized ITA may improve arterial revascularization outcomes in CABG.
• The skeletonization technique appears to offer a lower complication rate than conventional methods.