The outcomes of Skeletonized and Pedicled Internal Thoracic Artery in Patients undergoing coronary artery bypass grafting: a randomized clinical study

Background: Internal thoracic artery became the cornerstone graft in coronary artery bypass grafting. This study aimed to investigate sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized versus pedicled internal thoracic artery. Methods: 100 patients who underwent isolated CABG were divided into two groups; skeletonized internal thoracic artery (ITA) (50 patients) and pedicled internal thoracic artery (50 patients). The postoperative assessment was performed three months after surgery. Physical and radiological examinations were performed after surgery to assess sternal healing. Results: There was no significant difference in patients’ demographics between groups. Skeletonized group had more diabetic patients (65% vs 44%; p= 0.016). There was no significant difference between the two groups regarding the number of grafts (2.72 ± 0.89 vs. 2.68 ± 0.90; skeletonized vs pedicled group; p= 0.84). Harvesting time was longer in the skeletonized group (55.69 ± 8.80 vs. 44.28 ± 6.95 minutes; p=0.09). Superficial wound infection occurred more frequently in the pedicled group (24% vs. 8%; p=0.03). Conclusion: Skeletonization of the internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG compared to the pedicled technique. However, skeletonization of internal thoracic artery conduits prolongs the operation time and requires more surgical skills.

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Mobilizing the internal thoracic artery bilaterally for coronary artery bypass grafting in obese and diabetic patients

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)33726-2 ◽

1993 ◽

Vol 106 (4) ◽

pp. 753-754

Author(s):

A. Alameddine ◽

M. DeCamp ◽

H. Yanagi ◽

L.H. Cohn

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Diabetic Patients ◽

Bypass Grafting ◽

Artery Bypass Grafting

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Assessment of the Association of Bilateral Internal Thoracic Artery Skeletonization and Sternal Wound Infection After Coronary Artery Bypass Grafting

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2015.10.031 ◽

2016 ◽

Vol 101 (5) ◽

pp. 1677-1682 ◽

Cited By ~ 15

Author(s):

Fraser D. Rubens ◽

Li Chen ◽

Michael Bourke

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Wound Infection ◽

Coronary Artery Bypass ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Sternal Wound Infection ◽

Artery Bypass Grafting ◽

Bilateral Internal Thoracic Artery

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Commentary: Bilateral Versus Single Internal Mammary Arteries in Diabetic Patients Undergoing Coronary Artery Bypass Grafting—Is There a Sweet Spot?

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2020.10.029 ◽

2020 ◽

Author(s):

Dinela Rushani ◽

Derrick Y Tam ◽

Stephen E. Fremes

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Diabetic Patients ◽

Bypass Grafting ◽

Sweet Spot ◽

Artery Bypass Grafting ◽

Mammary Arteries ◽

Internal Mammary

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Faculty Opinions recommendation of Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11375.468863 ◽

2006 ◽

Author(s):

Richard Underwood

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

High Risk ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Spect Imaging ◽

Diabetic Patients ◽

Bypass Grafting ◽

Artery Bypass Grafting

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The effect of using the minimized cardio-pulmonary bypass Systems for Coronary Artery Bypass Grafting in diabetic patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01551-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Turki B. Albacker ◽

Mohammed Fouda ◽

Bakir M. Bakir ◽

Ahmed Eldemerdash

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Diabetic Patients ◽

Bypass Grafting ◽

Perioperative Myocardial Infarction ◽

Artery Bypass Grafting ◽

Bypass Group

Abstract Introduction Multiple studies have shown a decrease in the inflammatory response with minimized bypass circuits leading to less complications and mortality rate. On the other hand, some other studies showed that there is no difference in post-operative outcomes. So, the aim of this study is to investigate the clinical benefits of using the Minimized cardiopulmonary Bypass system in Coronary Artery Bypass Grafting and its effect on postoperative morbidity and mortality in diabetic patients as one of the high-risk groups that may benefit from these systems. Methods This is a retrospective study that included 114 diabetic patients who underwent Coronary artery bypass grafting (67 patients with conventional cardiopulmonary bypass system and 47 with Minimized cardiopulmonary bypass system). The patients’ demographics, intra-operative characteristics and postoperative complications were compared between the two groups. Results Coronary artery bypass grafting was done on a beating heart less commonly in the conventional cardiopulmonary bypass group (44.78% vs. 63.83%, p = 0.045). There was no difference between the two groups in blood loss or transfusion requirements. Four patients in the conventional cardiopulmonary bypass group suffered perioperative myocardial infarction while no one had perioperative myocardial infarction in the Minimized cardiopulmonary bypass group. On the other hand, less patients in the conventional group had postoperative Atrial Fibrillation (4.55% vs. 27.5%, p = 0.001). The requirements for Adrenaline and Nor-Adrenaline infusions were more common the conventional group than the Minimized group. Conclusion The use of conventional cardiopulmonary bypass for Coronary Artery Bypass Grafting in diabetic patients was associated with higher use of postoperative vasogenic and inotropic support. However, that did not translate into higher complications rate or mortality.

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