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 “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 Role of Gender, Smoking Profile, Hypertension, and Diabetes on Saphenous Vein and Internal Mammary Artery Endothelial Relaxation in Patients with Coronary Artery Bypass Grafting

2010 ◽  
Vol 3 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Andrew Duncan Muir ◽  
Pascal Patrick McKeown ◽  
Ulvi Bayraktutan
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Diabetic Patients ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Internal Mammary

The aim of this study was to investigate if there was a link between the relaxant responses in saphenous vein (SV) and internal mammary artery (IMA) segments obtained from patients undergoing coronary artery bypass grafting and the patients' cardiovascular risk factors. Endothelium-(in)dependent relaxations were assessed by isometric tension studies. Endothelium-dependent relaxant responses were greater in IMA than SV and gender, smoking profile and history of hypertension but not diabetes appeared to have an influence on these responses. Endothelium-dependent relaxant responses in both IMA and SV were greater in males than females and relaxant responses in IMA segments were attenuated in smokers, whereas the opposite effect was noted in SV segments. Endothelium-dependent relaxant responses in SV were lower in patients with hypertension. Endothelium-independent relaxant responses were greater in IMA than SV. Endothelium-independent responses were greater in male patients' SV segments, but gender played no role in IMA segments. Diabetes had no effect on endothelium-independent responses in IMA, but SV segments from diabetic patients had greater responses. Neither conduit's endothelium-independent response was affected by hypertensive status. The relationship between risk factor status and endothelial responses is multifactorial, with gender, hypertension, diabetes and smoking status all contributing.

Management of the recurrent sternal wound infection

1995 ◽  
Vol 3 (3) ◽  
pp. 1-10
Author(s):  
Geoffrey G Hallock
Keyword(s):  
Wound Infection ◽  
Internal Mammary Artery ◽  
Selection Process ◽  
Artery Bypass ◽  
Muscle Flap ◽  
Bypass Grafting ◽  
Sternal Wound Infection ◽  
Flap Transfer ◽  
Accepted Standard ◽  
Internal Mammary

After adequate sternal debridement or resection for the treatment of a sternal wound infection, muscle flap obliteration of the resulting void has become an accepted standard. Unfortunately, recurrence is not an inconsequential risk as evidenced in six (20.7%) of our patients over the last 10 years. Two of these patients required a second muscle flap transfer before obtaining a healed wound. Since the available regional options for appropriate vascularized flaps is limited, especially with the increased frequency in use of the internal mammary artery for coronary artery bypass grafting, great care must be observed in the selection process not just for closure of the initial wound, but in anticipation of untoward sequela. A schema prioritizing alternatives has been established, so as to maximize the benefit of our workhorse flaps, the pectoralis major or rectus abdominis muscles.

Effect of Pleurotomy During Internal Mammary Artery Harvest on Pulmonary Function

1970 ◽  
Vol 3 (2) ◽  
pp. 163-168
Author(s):  
AMA Rahim ◽  
G Kibria ◽  
NU Ahmed
Keyword(s):  
Pulmonary Function ◽  
Vital Capacity ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Internal Mammary ◽  
Group A ◽  
Study Population ◽  
Group B

Background: Pulmonary function after coronary artery bypass graft surgery using harvested Internal mammary artery(IMA) were assessed in this prospective case control Clinical study comparing two groups of Patients with or without pleurotomy. Method: we conducted this Study at National Institute of Cardiovascular Diseases (NICVD), Dhaka, in the Department of Cardiovascular Surgery.A total of 60 consecutive patients undergoing CABG with use of IMA between july 2005 to June 2007 were reviewed. Study population were divided into Group A (n=30,undergone CABG with pleurotomy during IMA harvestion).Group B (n=30,undergone CABG with intactpleura during IMA harvestion). Results: in lung function spirometry revealed FEV1 significantly decreased in group A than B (56.81±17.76% Vs 79.85±7.7%; p=0.035)and when FEV1correalated with inspiratory vital capacity the advantage of intact pleura were confirmed at 6th postoperative day (78.02 ±12.17; B, 82.08 ±11.72 p=0.045). Vital capacity was significantly decreased in-group A than B at 3 months postoperatively (A 88.79 ± 14.38%;B 98.11±30.25%; p=0.009), but not on 6th Postoperative day. Pleuropulmonary complication like atelectasis, pleural effusion insignificantly higher in groupA than B(16.7 %VS6.7%) and (10% vs. 6.7%)at 6th postoperative day but not at 3months postoperatively. Conclusions: These results demonstrate that pleurotomy during Internal mammary artery harvesting significantly deteriorated pulmonary function variably than intact pleura group of patients Keywords: Pleurotomy; Internal mammary artery(IMA); Pulmonary function; CABG DOI: http://dx.doi.org/10.3329/cardio.v3i2.9186 Cardiovasc. J. 2011; 3(2): 163-168

Left or bilateral internal mammary artery employment in coronary artery bypass grafting: midterm results

2021 ◽  
pp. 021849232199076
Author(s):  
Mikhail Sergeevich Fomenko ◽  
Yuri Alexandrovich Schneider ◽  
Victor Gennadievich Tsoi ◽  
Alexander Anatolyevich Pavlov ◽  
Pavel Alexandrovich Shilenko
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Mammary Arteries ◽  
Internal Mammary

Background The gold standard for coronary artery bypass grafting to the left anterior descending artery is use of the left internal mammary artery. Better long-term survival has been reported using bilateral internal mammary arteries compared to left internal mammary artery only, but many surgeons are reluctant to employ bilateral internal mammary arteries in coronary artery bypass grafting. This study aimed to evaluate the effectiveness and safety of bilateral internal mammary artery use. Methods From 2014 to 2017, 1703 patients underwent coronary artery bypass grafting in our institute. Of these, 772 met the inclusion criteria and were randomly assigned to receive bilateral ( n = 387) or left ( n = 385) internal mammary artery grafts. The mean age was 67.1 ± 6.0 years (range 48–85 years) and 474 (61.4%) were male. The mean number of diseased vessels was 3.1 ± 0.9, and mean EuroSCORE II was 3.4% ± 1.1%. Results Hospital mortality was 1.2% in the left internal mammary artery group vs. 1.8% in the bilateral internal mammary artery group ( p = 0.55). There was no difference in procedure-related complications between groups. Mean follow-up was 65.9 months. Survival in the bilateral internal mammary artery group at 1, 3, and 5 years was 98.7%, 98.7%, and 94.8% vs. 98.1%, 98.1%, and 90.9%, respectively, in the left internal mammary artery group ( p = 0.63). Conclusion Application of bilateral internal mammary arteries in coronary artery bypass grafting is safe and effective, with comparable midterm results to those with the left internal mammary artery only.

Prediction value of EuroSCORE II in total arterial revascularization and its usage in the evaluation of postoperative complications: Single-center experience

2021 ◽  
pp. 021849232199705
Author(s):  
Aleksandar V Milutinovic ◽  
Stasa D Krasic ◽  
Igor S Zivkovic ◽  
Andja M Cirkovic ◽  
Slobodan Z Lokas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Arterial Revascularization ◽  
Total Arterial Revascularization ◽  
Mammary Arteries ◽  
Internal Mammary

Background Total arterial revascularization is the most durable and technically the most demanding type of coronary artery bypass grafting procedure. It has proven long-term supremacy in comparison to conventional coronary artery bypass grafting. In our study, we investigated the reliability of EuroSCORE II as a predictor of intrahospital death. We showed its impact on adverse perioperative events. Methods In this nonrandomized prospective study, we analyzed 116 consecutive patients who underwent the total arterial revascularization procedure at our Institute from January 2011 until the present. For myocardial revascularization, the most suitable combinations with left internal mammary artery, right internal mammary artery, and radial artery grafts were used. Main fact in this research was intrahospital mortality value in comparison with the value predicted. Results There were 104 (89.7%) males and 12 (10.3%) females. Mean preoperative EuroSCORE II prediction value was 1.98% and postoperative we obtained 1.72%. Postoperative redo for bleeding was 6%. Positive correlation was proven between the EuoroSCORE II value and intensive care unit stay (0.452; p < 0.001). Among patients who received two internal mammary arteries, the highest EuroSCORE II was among those with presternal wound infection (p = 0.005). Patients with bilateral internal mammary arteries and diabetes showed that they have the highest values of EuroSCORE II and, at the same time, that they are extremely prone to wound problems. Conclusions We achieved a lower intrahospital mortality level than it was predicted with preoperative EuroSCORE II value. This tool is a reliable method for preoperative death risk calculation in this group of patients.

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