Background:
Skeletonization of internal thoracic arteries (ITA) is a popular technique in OPCAB surgery to increase length of arterial conduit and feasibility of «No-touch» revascularization. Impact of skeletonized (SK) ITA on long-term survival and cardiac events is not clearly defined.
Methods:
We reviewed 1000 consecutive patients having undergone OPCAB surgery at the Montreal Heart Institute, between September 1996 and March 2004 that were prospectively recorded in an OPCAB database. Among them, 994 had at least one ITA bypass.
Results:
Skeletonized ITA was used in 558 patients (56.1%). SK patients were older (p=0.045), had significantly more risk factors [dyslipidemia (p<0.001), hypertension (p<0.001), obesity (p=0.002)]. Preoperative Parsonnet score was not different between SK and non-SK groups. Use of bilateral ITA (p<0.001) and sequential grafting (p<0.001) were more frequent in SK group (36.6% vs 25.7% and 29.9% vs 0.7%, respectively). Operative mortality was similar (SK: 1.8% vs non-SK: 1.6%; p=0.82). Sternal wound infection rate was similar, but dehiscence rate was higher in the PD group (p=0.03). Hospital (p=0.27) and ICU (p=0.09) length of stay were similar in both groups. Overall 7-year survival was 83±2% in SK group and 80±2% in non-SK group (p=0.84). Long-term freedom from major adverse cardiac events was also similar between SK and non-SK groups (83±2% and 82±2%, respectively, p=0.4). Late rate rehospitalization for heart failure or revascularization (CABG or PCI) was similar for both groups. However, 7-year freedom from myocardial infarction was significantly better for non-SK group (p=0.04). By Cox regression analysis, COPD, cardiac heart failure, peripheral vascular disease, emergency and completeness of revascularization were independent predictors of late mortality whereas diabetes, skeletonization and the number of grafts by territory of revascularization were independent predictors of late myocardial infarction.
Conclusion:
ITA has no influence in long-term survival or major cardiac events in an all comer OPCAB population. However, SK and diabetes were predictors of late incidence of myocardial infarction. Thus, a word of caution should be made about skeletonization of the ITA in diabetic population.
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