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Comparison of endoscopic versus conventional internal mammary harvesting regarding unligated side branches
Mahmood Reza Sarzaeem1, Saleh Sandoughdaran, Hasan Peyvandi
1Cardiac Transplantation and Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran. dh.peyvandi@outlook.com
Insights
Endoscopic internal mammary artery (IMA) harvesting is more effective than conventional methods at ligating side branches. This thoracoscopic approach ensures fewer unligated branches remain, improving surgical outcomes.
Area of Science:
- Cardiovascular Surgery
- Anatomy
- Minimally Invasive Techniques
Background:
- Endoscopic vessel harvesting is increasingly used in cardiac surgery to minimize invasiveness.
- The endoscopic approach may leave proximal branches of the internal mammary artery (IMA) intact, potentially affecting collateral flow.
Purpose of the Study:
- To compare the number and anatomical variations of side branches remaining after thoracoscopic versus conventional internal mammary artery harvesting.
Main Methods:
- 199 fresh cadavers were divided into two groups: endoscopic IMA harvesting (n=100) and conventional open harvesting (n=99).
- Side branches of the IMA were identified and assessed for ligation status in both groups.
Main Results:
- Significantly fewer unligated side branches were found after endoscopic IMA harvesting (3 branches) compared to conventional harvesting (14 branches).
- No side branches remained unligated in the endoscopic group, while the first intercostal artery and lateral costal artery were unligated in 3% and 5% of cadavers in the conventional group.
- No arterial injuries occurred; however, the internal mammary vein was damaged in 2% of cadavers with conventional harvesting.
Conclusions:
- Thoracoscopic internal mammary artery harvesting demonstrates superior accuracy in identifying and ligating side branches.
- This technique minimizes the risk of leaving unligated branches, potentially enhancing surgical safety and efficacy.
Background:
In an effort to minimise access in cardiac surgery, endoscopic vessel harvesting has become more popular. The endoscopic approach, however, allows for only the harvest of the mid to distal internal mammary artery (IMA), leaving the more proximal branches of the conduit available for collateral flow away from the coronary bed.
Aim:
To compare the number and anatomic variation of remaining side branches in thoracoscopic vs. conventional IMA harvesting.
Methods:
199 fresh cadavers were randomly divided into two groups. Group A (n = 100) underwent endoscopic IMA harvesting. In Group B (n = 99), IMAs were harvested using an open conventional approach. In both groups during surgery, side branches of the IMA were isolated and identified.
Results:
The two groups were comparable with regard to mean age and age distribution, male sex (56% vs. 63%, respectively), cause of death and coronary risk factors including smoking, diabetes, dyslipidaemia and hypertension. 24 of 199 cadavers(12%) had a lateral costal branch. The left IMA arose from the third part of the subclavian artery in 6%, and from the thyrocervical trunk in 7% of the cadavers. There were significantly more unligated side branches in Group B compared to Group A (14 branches vs. 3 branches, p < 0.01). The first intercostal artery and lateral costal artery were found unligated in 3% and 5% of cadavers in Group B, whereas no side branch remained unligated in Group A. There was no subclavian artery or IMA injury in either group. Internal mammary vein was damaged in 2% of cadavers in Group B.
Conclusions:
Thoracoscopic left IMA harvesting is more accurate in finding and ligating the side branches of IMA.
