scholarly journals “Pleurotomy during CABG on the Clinical Outcome Following Left Internal Mammary Artery (LIMA) Harvesting”

2021 ◽  
Vol 8 (12) ◽  
pp. 5872-5878
Author(s):  
Md. Magfur Rahman
Keyword(s):  
Cardiac Surgery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Pulmonary Complications ◽  
P Value ◽  
Bypass Grafting ◽  
Internal Mammary ◽  
Group A ◽  
Group B

Background: The internal mammary artery (IMA) is the graft of choice for coronary artery bypass grafting (CABG) due to superior patency and enhanced patient survival. Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. Objective: To assess the impact of intact pleura during left internal mammary artery harvesting on clinical outcome. Materials and Methods: This Cross sectional observational study was carried out in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2019 to December 2019.101 patients who underwent Department of Cardiac Surgery, BSMMU were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 53, 45 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. Results: The Incidence Of Postoperative Pericardial Effusion Was Similar Between The Groups, But The Incidence Of Postoperative Pulmonary Complications Such As Pleural Effusion (Except For Mild Pleural Effusion) On The Second (No: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value < 0.001 and p value = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value < 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value = 0.002) were significantly higher in group A than those in group B. Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.

scholarly journals Sternal healing after bilateral internal mammary arteries use for Coronary artery bypass grafting in diabetic Patients; short-term results

2020 ◽  
Author(s):  
Islam Moheb Ibrahim ◽  
Ahmed Labib Dokhan ◽  
Yahia Balbaa Anwar Balbaa ◽  
Ibrahim Mohammed Khalil ◽  
Mohammed Ahmed El-Hag-Aly
Keyword(s):  
Wound Infection ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Diabetic Patients ◽  
Bypass Grafting ◽  
Risk Of Infection ◽  
Mammary Arteries ◽  
Internal Mammary ◽  
Group A ◽  
Group B

Background:  Bilateral internal mammary artery (BIMA) use may improve long-term outcomes after coronary artery bypass grafting (CABG); however, the risk of infection is high.   Skeletonization of the internal mammary may decrease the risk of infection, especially in patients with diabetes. Our study aimed at evaluation of sternal healing in diabetic patients with different techniques of bilateral internal mammary artery harvesting. Methods: This prospective randomized study included 200 diabetic patients who underwent CABG using BIMA between 2017 and 2019. We divided patients into two groups; Group A had skeletonization of both internal mammary arteries, and Group B had pedicled left mammary and skeletonized right mammary. Patients were observed for three months, post-operatively for any sternal wound problems. Results: There was no significant difference regarding the baseline variables. Type I diabetes mellitus was present in 25% in group A (n= 24) and 13.64% in group B (n= 12) (p= 0.324). There was no difference in harvest time between groups (83 ±4 vs. 81 ±3 minutes in group A vs. B, respectively. P= 0.1). The mean number of grafts was 3± 0.5 in Group A and 3± 0.6 in Group B (p= 0.8). Postoperative drainage was 402.9 ± 174.1 ml in Group A vs. 387.2 ± 153.6 ml in Group B (p= 0.474). The duration of ICU stay did not differ significantly between groups (2± 0.7 in Group A vs. 2± 0.5 in Group B; p= 0.8). Deep sternal wound infection occurred in 4.17% in group A (n= 4) and 4.55% in group B (n= 4) (p= 0.705). Superficial wound infection occurred in eight patients in group A (8.33%) and eight patients in group B (9.1%) (p= 0.59). No patient had sternal dehiscence in group A vs. four patients in group B (4.55%) (p= 0.39). Conclusion: We did not find differences between bilateral mammary artery harvest with skeletonization of both arteries versus skeletonization of the right mammary only on sternal healing nor wound infection in diabetic patients undergoing CABG. A larger study is recommended.

scholarly journals Chylothorax – a Rare Complication after Cardiac Surgery (a Case Report)

2011 ◽  
Vol 54 (1) ◽  
pp. 37-39
Author(s):  
Jiří Manďák ◽  
Petr Habal ◽  
Milan Štětina ◽  
Jan Harrer
Keyword(s):  
Cardiac Surgery ◽  
Biochemical Analysis ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Combined Treatment ◽  
Bypass Grafting ◽  
Pleural Drainage ◽  
Internal Mammary

Chylothorax is a rare but severe complication of cardiac surgery. The authors present the case of a 76-year-old woman suffering from ischemic heart disease, after coronary artery bypass grafting that included a left internal mammary artery pedicle graft. On the ninth postoperative day the left-sided fluidothorax developed. The results of biochemical analysis were consistent with the chyle. Combined treatment with pleural drainage and total parenteral nutrition was effective.

Comparison between Bilateral Internal Mammary Artery Graft and LIMAG in Patients Undergoing CA Bypass Grafting

2021 ◽  
Vol 15 (12) ◽  
pp. 3375-3377
Author(s):  
Ahmad Kamran Khan, ◽  
Syed Sardar Rahim ◽  
Malik Salman ◽  
Furqan Yaqub Pannu ◽  
Bilal Ahmed ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Wound Infection ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
P Value ◽  
Bypass Grafting ◽  
Internal Mammary

Background: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over Left internal mammary artery for coronary artery bypass grafting (CABG). However, there are still uncertainties about which surgical approach is the best one to use with BIMA grafting. Objective: To compare Bilateral Internal Mammary Artery (BIMA) Grafting with Left Internal Mammary Artery (LIMA) Grafting during Coronary Artery Bypass Grafting (CABG) in terms of early mortality and sternal wound infections. Materials & Methods Randomized: control trialtechnique enrolled. The study was conducted at the Cardiac Surgery Department, King Edward Medical University (KEMU), Mayo Hospital Lahore Results: Total 96patients undergoing CABG were included in this study. Patients were randomly divided into 2 groups; each group contains 48 patients. Group A included patients having Left IMA to LAD; second and third graft by Great Saphenous Vein and Group B included patients having Bilateral Internal Mammary Arteries with Left IMA to LAD or OM and Right IMA to RCA, LAD or Ramus Intermedius. The superficial and deep sternal wound infections was recorded along with the different risk factors including diabetes, obesity, hypertension, smoking and use of inotropes intra-operatively and post operatively. The incision site over the sternum was being evaluated on daily basis throughout the stay of the patients (from 5–8 days). Diagnosis of Sternal infections was based on the presence of positive cultures, dehiscence of the sternum incision, fever, redness pain, and infected (purulent) secretions. Sternal instability and discharge, ventilation time, length of ICU stay, chest drainage, re-exploration and length of hospital stay was also recorded. Results:Not any of the patients included in these two treatment groups suffered from mortality (LIMA: 0%, BIMA: 0%). Deep sternal wound infection [LIMA: 4.17% & BIMA: 6.25%, p-value=0.646] and superficial wound infection [LIMA: 4.17% & BIMA: 6.25%, p-value=0.646] did not show any statistically significant association towards both grafts type. Patients who underwent BIMA grafting suffered from higher in hospital stay as compared to patients who underwent LIMAgrafting. i.e. [LIMA: 7.02 & BIMA: 8.02, P value = 0.000] Conclusion: Results of the study showed no significant difference for deep sternal wound infection and superficial wound infection between the two grafts BIMA and LIMA. However, patients who underwent BIMA grafting had significantly higher hospital stay as compared to patients who underwent LIMA grafting. Keywords: Bilateral, Internal, Mammary Artery, Grafting, Left, Internal Mammary Artery, Coronary Artery, Bypass, Grafting, Mortality, Sternal wound infections.

scholarly journals On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Muhammad Sher-i-Murtaza ◽  
Mirza Ahmad Raza Baig
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Hemodynamic Instability ◽  
Bypass Grafting ◽  
Operative Strategy ◽  
Internal Mammary

Objective: To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery. Methods: The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19. Results: In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424. Conclusions: The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit. doi: https://doi.org/10.12669/pjms.35.3.988 How to cite this:Sher-i-Murtaza M, Baig MAR. On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study. Pak J Med Sci. 2019;35(3):---------.  doi: https://doi.org/10.12669/pjms.35.3.988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Internal mammary artery with side-branch

2016 ◽  
Vol 25 (3) ◽  
pp. 210-212
Author(s):  
Sergii Galych ◽  
Sergii Solomka ◽  
Bogdan Batsak ◽  
Anatoliy Rudenko ◽  
Uriy Starodub
Keyword(s):  
Coronary Arteries ◽  
Internal Mammary Artery ◽  
Internal Thoracic Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Side Branch ◽  
Bypass Grafting ◽  
Off Pump ◽  
Internal Mammary ◽  
Pump Coronary Artery Bypass

We present the case of a 72-year-old man who underwent off-pump coronary artery bypass grafting of 4 coronary arteries with exclusive use of the left internal mammary artery with a side-branch (mediastinal artery). Before discharge from the hospital, contrast computed tomography angiography confirmed the patency of all 4 coronary grafts. Use of the mediastinal artery side-branch of the internal mammary artery allowed grafting of 4 coronary arteries using only one internal thoracic artery.

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