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Functional and Morphological Assessment of Diaphragm Innervation by Phrenic Motor Neurons
Published on: May 25, 2015
Skeletonization does not influence internal thoracic artery innervation.
Mario Gaudino1, Amelia Toesca, Franco Glieca
1Department of Cardiac Surgery, Institute of Human Anatomy, Catholic University, Rome, Italy. mgaudino@tiscali.it
The Annals of Thoracic Surgery
|April 6, 2004
Summary
Skeletonization of the internal thoracic artery (ITA) for coronary artery bypass grafting does not affect its nerve supply. This surgical technique also does not lead to denervation supersensitivity in the grafts.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Techniques
Background:
- The internal thoracic artery (ITA) is a preferred graft for coronary artery bypass grafting.
- Surgical harvesting techniques, including skeletonization and pedicling, may impact graft innervation.
- Potential denervation supersensitivity in skeletonized grafts requires investigation.
Purpose of the Study:
- To compare the effect of surgical harvesting on ITA innervation.
- To assess for denervation supersensitivity in skeletonized ITA grafts.
Main Methods:
- Nineteen patients undergoing primary isolated coronary artery bypass grafting were randomized to receive skeletonized (n=9) or pedicled (n=10) ITA grafts.
- Immunohistochemistry using anti-S-100, anti-160-kd neurofilament, and anti-tyrosine hydroxylase antibodies evaluated nerve localization in distal arterial specimens.
- Endovascular challenges with serotonin and methylergometrine assessed for denervation supersensitivity at early angiographic follow-up.
Main Results:
- Quantitative immunohistochemical analysis showed no significant difference in positive cell counts between skeletonized and pedicled ITA specimens for all antibodies.
- Vasoactive challenges revealed no difference in the response to serotonin or methylergometrine between the two graft types.
Conclusions:
- Skeletonization of the internal thoracic artery does not alter its vascular innervation.
- The skeletonization technique does not induce denervation supersensitivity in ITA grafts.
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