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Hospital outcome analysis after different techniques of left internal mammary grafts harvesting
Francesco Onorati1, Antonio Esposito, Francesco Pezzo
1Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Naples, Italy. frankono@libero.it
Insights
The pedicled versus skeletonized left internal mammary artery (LIMA) technique for coronary artery bypass graft surgery shows similar functional outcomes. However, the pedicled LIMA approach has a higher risk of minor wound complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- The left internal mammary artery (LIMA) is the preferred conduit for myocardial revascularization.
- Debate exists regarding the optimal harvesting technique: pedicled versus skeletonized.
- Emerging evidence suggests skeletonized LIMA may offer improved outcomes.
Purpose of the Study:
- To compare the functional behavior and clinical outcomes of pedicled versus skeletonized LIMA grafts.
- To evaluate graft flow reserve, hemodynamic parameters, and hospital outcomes.
- To assess the impact of harvesting technique on perioperative complications.
Main Methods:
- A retrospective analysis of 516 isolated coronary artery bypass graft surgery patients.
- Patients were grouped based on LIMA harvesting technique: 387 pedicled and 129 skeletonized.
- Analysis included transit time flow, troponin I levels, echocardiography, and hospital outcomes.
Main Results:
- No significant differences in maximum, mean, or minimum flows, pulsatility index, or graft flow reserve between pedicled and skeletonized LIMA.
- Comparable on-pump and off-pump surgical outcomes, including troponin leakage and echocardiographic recovery.
- Superficial wound complications were significantly higher in the pedicled LIMA group (2.6% vs. 0%; p=0.05).
Conclusions:
- Both pedicled and skeletonized LIMA techniques demonstrate similar in-vivo functional behavior and hospital outcomes.
- The pedicled LIMA technique is associated with an increased risk of minor wound complications.
- Current evidence does not support a preference for one LIMA harvesting technique over the other based on functional or clinical outcomes.
Background:
Although accepted worldwide as the first-choice conduit for myocardial revascularization (coronary artery bypass graft surgery), it is still questionable if left internal mammary arteries (LIMAs) do better as pedicled or skeletonized grafts. Recent reports have suggested that the skeletonized technique improves the outcomes.
Methods:
In all, 516 consecutive isolated coronary artery bypass graft surgery patients admitted between January 2003 and February 2007 were grouped according to the harvesting technique of LIMAs (387 pedicled versus 129 skeletonized). Intraoperative transit time flow results, hospital outcome, perioperative troponin I leakage, and echocardiographic results were analyzed. Maximum, mean, and minimum flows, pulsatility index, and graft flow reserve were stratified according to the type of surgery (on pump and off pump) and subgroups at risk (severe left ventricular hypertrophy).
Results:
The transit time flow results were unsatisfactory in 4 patients (0.8%), all 4 of whom underwent redo anastomosis. Maximum, mean, and minimum flows and pulsatility index values were comparable between skeletonized and pedicled LIMAs (p = not significant), for both on-pump and off-pump surgeries (p = not significant). Graft flow reserve was comparable between the two groups (p = not significant), as well as transit time flow results in severe ventricular hypertrophy. Troponin leakage, postoperative echocardiographic recovery, and hospital outcome were comparable between the two groups (p = not significant at all time points). Only superficial wound complications proved higher in the pedicled group (2.6% versus skeletonized group: 0%; p = 0.05).
Conclusions:
Pedicled LIMA carries a higher risk for minor wound complications. Neverthless, the two techniques showed similar in-vivo functional behavior and hospital outcome. Therefore, there is no reason to prefer one technique over the other.
