Ischemic Heart Disease
Conditions
Keywords
sternotomy, thermography, coronary bypass, LIMA, skeletonization technique
Brief summary
The skeletonization technique of left internal artery (LIMA) harvesting is reported as more spar-ing to the vascular supply of the sternum. Some studies report a greater length and greater flow of the graft additionally. The aim of our study was to measure the difference in post-op sternal blood supply compared to the pedicle harvesting technique and to measure the length and flow of the LIMA graft.
Detailed description
A total of 90 patients were examined in a prospective randomized study. In 60 patients referred for coronary artery bypass grafting (CABG), LIMA was harvested, one-half (n=30) skeletonized, and one-half (n=30) with a pedicle. Thirty patients operated via sternotomy without LIMA harvesting (other procedures, for instance, valve surgery) were the control group. In patients undergoing LIMA harvest, harvest duration, graft length, and graft free flow were measured at defined arterial pressure. In all patients, the sternal blood flow was examined by active dynamic thermography (DIRT): first preoperatively and on 4th postoperative day. During this, the time of spontaneous rewarming of the skin surface after the application of a cold stimulus was measured in the caudal part of the sternum. The difference between postoperative and preoperative time was calculated and compared between groups.
Interventions
PROCEDUREThe mammary artery harvesting by the pedicle technique
The mammary artery harvesting by the pedicle technique was used in the LIMA pedicle study group.
PROCEDUREThe mammary harvesting using the skeletonization technique
The mammary harvesting using the skeletonization technique was used in the LIMA skeletonized study group.
PROCEDURENo intervention
No intervention was used in the control study group.
Sponsors
University Hospital Ostrava
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Elective cardiac surgery procedure via median sternotomy * The left mammary artery (LIMA) harvesting for coronary bypass planned as a part of the operation - Group 1 and 2 * Other cardiac surgery procedures without the LIMA harvesting (valve surgery for instance) - Control group * Signing of the informed consent
Exclusion criteria
* Emergent surgery * Re-operation * Re-sternotomy * Thoracotomy approach * Harvesting of both mammary arteries (BIMA) * Endocarditis * Ongoing non-cardiac infection * Fever * Circulatory failure * Ongoing administration of catecholamines to patient * Unsigned informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rewarming time difference | first preoperatively and on 4th postoperative day | Duration of spontaneous rewarming of the skin surface of the caudal sternum after a cold stimulus, measured from 24°C to 27°C. Unit: seconds (s) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of the mammary graft harvesting | during surgery, immediately after the graft harvesting | Time from the start of the harvesting to complete graft release. Unit: minute (min). |
| Length of the mammary artery graft | during surgery, immediately after the graft harvesting | Length from the distance of the graft from the chest wall to its distal end. Unit: millimeter (mm). |
| Free outflow of the mammary artery | during surgery, just before the graft use | After trimming the distal clip on the graft at an arterial pressure of 70 mmHg, free flow for 30 seconds, then multiplied by two. Unit: millilitre per minute (ml/min). |
Countries
Czechia
Outcome results
None listed