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Left Internal Mammary Artery Skeletonization Reduces Bleeding-A Randomized Controlled Trial.
Piotr Mazur1, Radosław Litwinowicz2, Vakhtang Tchantchaleishvili3
1Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Skeletonized left internal mammary artery (LIMA) harvesting significantly reduces mediastinal drainage after coronary artery bypass grafting (CABG) compared to pedicled LIMA. This technique also lowered blood transfusions and myocardial necrosis markers.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Techniques
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac procedure.
- Left internal mammary artery (LIMA) is frequently used as a graft in CABG.
- Harvesting techniques for LIMA, skeletonized versus pedicled, may impact surgical outcomes.
Purpose of the Study:
- To compare the impact of skeletonized versus pedicled LIMA harvesting on postoperative bleeding in CABG patients.
- To evaluate the effect of LIMA harvesting technique on myocardial necrosis markers.
Main Methods:
- A randomized, single-blinded trial with parallel group design was conducted.
- 62 patients undergoing primary elective CABG were assigned to either skeletonized or pedicled LIMA dissection.
- Postoperative cumulative drainage at 12 hours and myocardial necrosis markers were monitored.
Main Results:
- Skeletonized LIMA harvesting resulted in a 28% reduction in 12-hour mediastinal drainage compared to pedicled LIMA (P = .02).
- Patients receiving pedicled LIMA required more fresh-frozen plasma transfusions (P = .03).
- Skeletonized LIMA was associated with significantly lower creatine kinase levels post-surgery.
Conclusions:
- Skeletonized LIMA harvesting leads to less mediastinal drainage after CABG compared to pedicled LIMA harvesting.
- The skeletonized technique appears to be associated with improved short-term outcomes regarding bleeding and myocardial injury.
