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Postoperative pleural changes after coronary revascularization. Comparison between saphenous vein and internal
M J Peng1, F S Vargas, A Cukier
1Instituto do Coracao, Faculty of Medicine, University of Sao Paulo, Brazil.
Insights
Coronary artery bypass grafting (CABG) surgery often results in pleural effusion and thickening, regardless of whether saphenous vein grafts (SVG) or internal mammary artery grafts (IMA) are used. These changes are typically minor and do not require intervention.
Area of Science:
- Cardiothoracic Surgery
- Thoracic Radiology
- Pulmonary Medicine
Background:
- Coronary artery bypass grafting (CABG) commonly utilizes saphenous vein grafts (SVG) and internal mammary artery grafts (IMA).
- Pleural changes post-CABG are common, with a hypothesis that IMA grafting, often involving pleurotomy, may increase their incidence.
Purpose of the Study:
- To investigate the incidence of pleural changes after CABG.
- To compare pleural changes between patients receiving SVG only versus those receiving IMA grafts.
Main Methods:
- Retrospective review of chest roentgenograms from 122 patients undergoing CABG.
- Analysis of pre-operative and 6th post-operative day imaging.
- Comparison of pleural effusion and thickening rates between SVG and IMA groups.
Main Results:
- Overall incidence of pleural effusion post-CABG was approximately 40%.
- No significant difference in effusion rates between SVG (43%) and IMA (41%) groups.
- Higher incidence of pleural thickening in the IMA group (49%) compared to SVG group (31%), though not statistically significant.
- Most effusions were small, unilateral, left-sided, and asymptomatic.
Conclusions:
- A high incidence of small pleural effusions and thickening occurs after CABG.
- The type of graft (SVG vs. IMA) does not significantly influence the incidence of pleural effusion or thickening.
- Pericardial inflammation is speculated as a cause for post-CABG effusions.
Abstract:
Coronary artery bypass grafting (CABG) is commonly performed with a saphenous vein graft (SVG) and/or an internal mammary artery graft (IMA). We hypothesized that there would be a higher incidence of pleural changes after CABG in patients who underwent IMA grafting because pleurotomy is usually performed. In the present study, the pre and the 6th postoperative day chest roentgenograms of 122 patients who received CABG were reviewed. The incidence of effusion in the patients who received only SVG was 43 percent (23/54) and did not differ significantly (p greater than 0.05) from the incidence in the patients who also had IMA 41 percent (28/68). Almost all of the patients (43/51) had unilateral left-sided pleural effusions. Most of the effusions were small and did not require treatment. The incidence of effusion was not higher in patients with enlargement of their cardiac silhouette or atelectasis and was not related to the presence of chest tubes. The incidence of pleural thickening was higher in the IMA group (49 percent) than in the SVG group (31 percent) but the difference did not achieve statistical significance (p greater than 0.05). We conclude that there is a high (approximately 40 percent) incidence of small effusions and thickening after CABG. The incidence of pleural effusion and pleural thickening do not appear to be influenced by the type of surgery (IMA vs SVG). We speculate that the effusions are due to pericardial inflammation.