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Decreasing sternum microcirculation after harvesting the internal thoracic artery
Hiroyuki Nishi1, Masataka Mitsuno, Hiroe Tanaka
1Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
Insights
Internal thoracic artery (ITA) harvesting for coronary artery bypass grafting reduces sternal blood flow, particularly in the retrosternal middle section. Skeletonized and pedicled ITA harvesting methods show similar impacts on sternal microcirculation.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Research
Background:
- Internal thoracic artery (ITA) harvesting is a common procedure in coronary artery bypass grafting (CABG).
- The impact of ITA harvesting on sternal blood supply and microcirculation remains incompletely understood.
- Maintaining sternal viability is crucial for preventing complications like sternal dehiscence and infection.
Purpose of the Study:
- To evaluate the effect of ITA harvesting on sternal microcirculation using a novel laser Doppler flow meter.
- To compare the impact of skeletonized versus pedicled ITA harvesting techniques on sternal blood supply.
- To assess changes in presternal and retrosternal blood flow at different sternal levels.
Main Methods:
- A prospective study involving 46 patients undergoing CABG, divided into skeletonized (n=23) and pedicled (n=23) left ITA groups.
- Right ITA were harvested using the skeletonized method.
- Sternal blood flow was measured using a novel laser Doppler flow meter (1-mm depth, 780-nm laser) at presternal and retrosternal sites (upper, middle, lower) before and after ITA harvesting.
Main Results:
- A significant decrease in retrosternal microcirculation was observed in the middle sternal region across all patients (p < 0.05).
- No significant changes in blood flow were noted in other sternal regions or presternal areas.
- Both skeletonized and pedicled left ITA harvesting resulted in decreased middle retrosternal blood flow, with no significant difference between the techniques. Right ITA harvesting also affected middle and lower retrosternal flow.
Conclusions:
- ITA harvesting negatively impacts sternal microcirculation, specifically in the retrosternal middle section.
- The skeletonized harvesting technique offers no discernible advantage over the pedicled technique in preserving sternal microcirculation.
- Further research may explore strategies to mitigate sternal hypoperfusion following ITA harvesting.
Objective:
The effect of harvesting the internal thoracic artery (ITA) on blood supply to the sternum is not completely understood. Using a novel laser Doppler flow meter, we evaluated changes in sternum microcirculation prior to and after ITA harvesting.
Methods:
Forty-six patients (37 males, 69.4 ± 7.9 years) scheduled for coronary artery bypass grafting were enrolled into the study and divided into skeletonized (n = 23) and pedicled (n = 23) groups of patients with a left ITA. All right ITA were harvested using the skeletonized method. Sternal blood flow was measured presternally and retrosternally in the upper, middle, and lower sternal parts with a novel laser Doppler flow meter that measures blood flow at 1-mm depth using a 780-nm laser. Following median sternotomy, blood flow was measured before and after ITA harvesting.
Results:
In all patients (46 left and 16 right ITA cases), the middle part of the retrosternal microcirculation deteriorated (middle: pre- 2.71 ± 1.49, post- 2.43 ± 1.01 ml min(-1)100 g(-1); p < 0.05), while blood flow of other parts did not change. In patients with left ITA divided into skeletonized and pedicled groups, although middle retrosternal blood flow decreased after harvesting in both groups, there was no difference in deterioration between the groups. In patients with right ITA, the middle and lower retrosternal blood flow also deteriorated.
Conclusions:
The degree of sternal microcirculation damage after ITA harvesting is not different between skeletonized and pedicled group patients, suggesting that skeletonization is not advantageous for maintaining sternal microcirculation.
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