Does the use of the skeletonized internal thoracic artery result in less postoperative bleeding than the pedicled internal thoracic artery in coronary artery bypass surgery?

Objective: To compare the postoperative bleeding between the skeletonized grafts and pedicled internal thoracic artery (ITA) in coronary artery bypass. Material and Method: 132 elective patients submitted to the surgery of myocardial revascularization were retrospectively analyzed and the sample was equally distributed in groups according to the dissection performed on the ITA: G1, skeletonized and G2, pedicled. In both methods, the dissection was finished before the heparinization and the installation of extracorporeal circulation. The following clinical parameters were evaluated: extracorporeal circulation time, aortic clamping, drainage debit and administration of hemocomponents (erythrocytes and platelets). Results: The average number of platelets concentrations and the drainage debit on the postoperative period were statistically higher for the pedicled dissection of the ITA compared to the skeletonized one. No statistically significant differences were observed regarding the use of one or two mammary arteries, as well as for the time of extracorporeal circulation and anoxia in the studied groups. Conclusion: The skeletonized preparation of the internal thoracic artery significantly reduced the blood loss after an elective surgery of myocardial revascularization.

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“Beyond Beating Heart Surgery” Heartstring Device Protects against Perioperative Neurological Events

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181d8548f ◽

2010 ◽

Vol 5 (2) ◽

pp. 118-121 ◽

Cited By ~ 5

Author(s):

Andreas G. Sakopoulos ◽

John G. Jacobson ◽

Don R. Wilson ◽

Wilfred M. Huse

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Heart Surgery ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Off Pump ◽

Mammary Arteries

Objective There is a growing body of evidence favoring off-pump coronary artery bypass surgery (OPCAB) over traditional coronary artery bypass surgery (CABG) with cardiopulmonary bypass as a method for reducing perioperative neurologic events. Aortic manipulation, whether with OPCAB or coronary artery bypass surgery with cardiopulmonary bypass, is strongly linked with adverse neurologic outcomes. Although the aortic “no-touch” technique has merit, most cardiac surgeons are reluctant to base entire myocardial revascularization exclusively on mammary pedicles. The purpose of this study was to analyze our experience with OPCAB combined with the use of a Heartstring proximal anastomotic device, as a strategy for reducing clinically evident cerebrovascular accidents. Methods Two hundred twenty-seven consecutive isolated OPCAB were performed without the use of a side-biting aortic clamp. In all these operations, a Heartstring device was used, permitting clampless hand-sutured proximal anastomoses. All patients were managed in this fashion regardless of the status of their ascending aorta. A mean of 3.4 bypasses were performed during each operation, with one or two mammary arteries harvested routinely. In 98% of patients, a single proximal anastomosis was performed; there was liberal use of sequential bypass grafts. Results Mean age was 69.3 years, with 17% octogenarians. Preexisting cerebrovascular disease was present in 22.4% of patients. There were no clinically evident perioperative neurologic events in any patients. There were no operative deaths. Conclusions This series suggests that OPCAB performed with a single, clampless, proximal aortic anastomosis, and with a Heartstring device may protect against perioperative strokes.

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