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Skeletonization of Left Internal Mammary Artery in Coronary Artery Bypass Grafting
Muhammad Sohail Chaudhri1, Muhammad Usman Ali Shah1, Muhammad Imran Asghar1
1Department of Cardiac Surgery,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi.
Insights
Skeletonized internal mammary artery (IMA) shows superior blood flow compared to the pedicled technique during coronary artery bypass grafting (CABG). This finding supports the use of skeletonized IMA for myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Myocardial Revascularization
Background:
- The left internal mammary artery (LIMA) is a preferred conduit for coronary artery bypass grafting (CABG).
- Harvesting techniques, skeletonized versus pedicled, may influence graft performance.
Purpose of the Study:
- To compare the mean per-operative flow capacity of skeletonized versus pedicled LIMA in CABG patients.
- To evaluate the efficacy of different LIMA harvesting methods.
Main Methods:
- A randomized controlled trial was conducted with 140 patients undergoing CABG.
- Patients were divided into two groups: skeletonized LIMA (70) and pedicled LIMA (70).
- Intraoperative free flow of LIMA was measured manually in milliliters per minute.
Main Results:
- The mean age of patients was 57.16 years.
- Triple-vessel disease was present in 84.3% of patients.
- Significantly higher free flow was observed in the skeletonized LIMA group compared to the pedicled LIMA group (p=0.04).
Conclusions:
- Skeletonized LIMA demonstrates superior intraoperative flow capacity compared to the pedicled technique.
- The findings support the increased use of skeletonized LIMA as a conduit for myocardial revascularization.
- This technique offers advantages beyond its established benefits.
Objective:
To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery (LIMA) in patients undergoing coronary artery bypass grafting (CABG) surgery.
Study Design:
Randomized control trial.
Place And Duration Of Study:
Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from February to August, 2013.
Methodology:
Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMAharvesting. Free flow was checked just before anastamosis of each LIMAto the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. Aspecialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18.
Results:
The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group (p=0.04).
Conclusion:
Skeletonized IMAhad superior flow to pedicled IMAin addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization.
