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Should We Hesitate to Use Skeletonized Bilateral Internal Mammary Artery?

Year 2022, Volume: 25 Issue: 3, 235 - 239, 01.12.2022

Abstract

Introduction: This study aimed to examine the mortality and morbidity associated with skeletonized BIMA use as well as the long-term outcomes of the technique.

Patients and Methods: Patients who underwent CABG with or without additional intervention by using skeletonized BIMA in our clinic between the years 2017 and 2021 were included in this study (n= 193).

Results: During the six-month postoperative follow-up, none of the patients in whom BIMA was used developed deep sternal wound infection. Only ten patients developed skin closure defects at the sternal incision line during the first postoperative week, and one of them required revision of the skin incision site. Bacterial growth was not present on the sternal incision site cultures of any patients.

Conclusion: When considering the long-term outcomes of skeletonized BIMA use, we believe that surgeons should not be reluctant to use BIMA due to concerns about deep sternal wound infection.

References

  • 1. Parissis H, Soo AW, Al-Alao B. Is there any further advantage of using more than one internal mammary artery? Asian Cardiovasc Thorac Ann 2013;21(1):101-13. [Crossref]
  • 2. Lytle BW. Bilateral internal thoracic artery grafting. Ann Cardiothorac Surg 2013;2(4):485-92.
  • 3. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: Pathogenesis, predisposition, and prevention. Circulation 1998;97(9):916-31. [Crossref]
  • 4. Umakanthan J, Jeyakumar P, Umakanthan B, Jeyakumar N, Senthilkumar N, Saraswathy M, et al. Barriers to the universal adoption of bilateral internal mammary artery grafting. Int J Surg 2015;16:179-82. [Crossref]
  • 5. Buxton BF, Hayward PA. The art of arterial revascular- izationdtotal arterial revascularization in patients with triple vessel coronary artery disease. Ann Cardiothorac Surg 2013;2(4):543-51.
  • 6. FitzGibbon GM, Kafka HP, Leach AJ, Burton JR. Interventions for coronary stenosisda Canadian experience of 30 revolutionary years. Can J Cardiol 1996;12(10):893-900.
  • 7. Bourassa MG. Long-term vein graft patency. Curr Opin Cardiol 1994;9(6):685-91. [Crossref]
  • 8. Magee MJ, Alexander JH, Hafley G, Ferguson B, Gibson M, Harrington R, et al. Coronary artery bypass graft failure after on-pump and off-pump coronary artery bypass: Findings from PREVENT IV. Ann Thorac Surg 2008;85(2):494-9. [Crossref]
  • 9. Cohn LH. Cardiac Surgery in the Adult. 3rd ed. London: McGraw-Hill Medical, 2008.
  • 10. Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 2004;77(1):93-101. [Crossref]
  • 11. Erden A, Saso S, Ashrafian H, Athanasiou T. Does a skeletonized or pedicled left internal thoracic artery give the best graft patency? Interact Cardiovasc Thorac Surg 2010;10(1):97-104. [Crossref]
  • 12. Keeley SB. The skeletonized internal mammary artery. Ann Thorac Surg 1987;44(3):324-5. [Crossref]
  • 13. Hu X, Zhao Q. Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary artery bypass surgery for good quality grafts. Ann Thorac Surg 2011;92(1):48-58. [Crossref]
  • 14. Athanasiou T, Crossman MC, Asimakopoulos G, Ashok C, Weerasinghe A, Glenville B, et al. Should the internal thoracic artery be skeletonized? Ann Thorac Surg 2004;77(6):2238-46. [Crossref]
  • 15. Momin AU, Deshpande R, Potts J, El-Gamel A, Marrinan M, Omigie J, et al. Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting. Ann Thorac Surg 2005;80(5):1765-72. [Crossref]
  • 16. Svensson LG, Mumtaz MA, Blackstone EH, Feng J, Banbury M, Sabik J, et al. Does use of a right internal thoracic artery increase deep wound infection and risk after previous use of a left internal thoracic artery? J Thorac Cardiovasc Surg 2006;131(3):609-13. [Crossref]
  • 17. Kamiya H, Akhyari P, Martens A, Karck M, Haverich A, Lichtenberg A. Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: A randomized study. J Thorac Cardiovasc Surg 2008;135(1):32-7. [Crossref]
  • 18. Deo SV, Shah IK, Dunlay SM, Erwin P, Locker C, Altarabsheh S, et al. Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients. Ann Thorac Surg 2013;95(3):862-9. [Crossref]
  • 19. Taggart DP, Douglas D, Altman DG, Gray AM, Lees B, Gerry S, et al. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J 2010;31(20):2470-81. [Crossref]
  • 20. Rihal CS, Eagle KA, Mickel MC, Foster D, Sopko G, Gersh B. Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. Circulation 1995;91(1):46-53. [Crossref]
  • 21. Van Straten AH, Firanescu C, Soliman Hamad MA, Tan SH, Woorst FJ, Martens EJ, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: Comparison with a matched general population. Ann Thorac Surg 2010;89(2):414-20. [Crossref]
  • 22. Collison T, Smith JM, Engel AM. Peripheral vascular disease and outcomes following coronary artery bypass graft surgery. Arch Surg 2006;141(12):1214-8. [Crossref]
  • 23. Karthik S, Musleh G, Grayson AD, Keenan JM, Pullan DM, Dihmis W, et al. Coronary surgery in patients with peripheral vascular disease: Effect of avoiding cardiopulmonary bypass. Ann Thorac Surg 2004;77(4):1245-9. [Crossref]
  • 24. Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: A systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001;358(9285):870-5. [Crossref]
  • 25. Kurlansky PA, Traad EA, Dorman MJ, Galbut DL, Zucker M, Ebra G. Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. Ann Thorac Surg 2010;90(1):101-8. [Crossref]
  • 26. Gottlob R. Ascending arteriography and evaluation of aortographic pictures. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 1954;277(5):483-9. [Crossref]
  • 27. Hardman RL, Lopera JE, Cardan RA, Trimmer CK, Josephs SC. Common and rare collateral pathways in aortoiliac occlusive disease: A pictorial essay. AJR Am J Roentgenol 2011;197(3):519-24. [Crossref]
  • 28. Dietzek AM, Goldsmith J, Veith FJ, Sanchez LA, Gupta SK, Wengerter KR. Interruption of critical aortoiliac collateral circulation during nonvascular operations: A cause of acute limb-threatening ischemia. J Vasc Surg 1990;12(6):645-53. [Crossref]
  • 29. Yapici F, Tuygun AG, Tarhan IA, Yılmaz M, Tuygun AK, Yapıcı N, et al. Limb ischemia due to use of internal thoracic artery in coronary bypass. Asian Cardiovasc Thorac Ann 2002;10(3):254-5. [Crossref]
Year 2022, Volume: 25 Issue: 3, 235 - 239, 01.12.2022

Abstract

References

  • 1. Parissis H, Soo AW, Al-Alao B. Is there any further advantage of using more than one internal mammary artery? Asian Cardiovasc Thorac Ann 2013;21(1):101-13. [Crossref]
  • 2. Lytle BW. Bilateral internal thoracic artery grafting. Ann Cardiothorac Surg 2013;2(4):485-92.
  • 3. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: Pathogenesis, predisposition, and prevention. Circulation 1998;97(9):916-31. [Crossref]
  • 4. Umakanthan J, Jeyakumar P, Umakanthan B, Jeyakumar N, Senthilkumar N, Saraswathy M, et al. Barriers to the universal adoption of bilateral internal mammary artery grafting. Int J Surg 2015;16:179-82. [Crossref]
  • 5. Buxton BF, Hayward PA. The art of arterial revascular- izationdtotal arterial revascularization in patients with triple vessel coronary artery disease. Ann Cardiothorac Surg 2013;2(4):543-51.
  • 6. FitzGibbon GM, Kafka HP, Leach AJ, Burton JR. Interventions for coronary stenosisda Canadian experience of 30 revolutionary years. Can J Cardiol 1996;12(10):893-900.
  • 7. Bourassa MG. Long-term vein graft patency. Curr Opin Cardiol 1994;9(6):685-91. [Crossref]
  • 8. Magee MJ, Alexander JH, Hafley G, Ferguson B, Gibson M, Harrington R, et al. Coronary artery bypass graft failure after on-pump and off-pump coronary artery bypass: Findings from PREVENT IV. Ann Thorac Surg 2008;85(2):494-9. [Crossref]
  • 9. Cohn LH. Cardiac Surgery in the Adult. 3rd ed. London: McGraw-Hill Medical, 2008.
  • 10. Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 2004;77(1):93-101. [Crossref]
  • 11. Erden A, Saso S, Ashrafian H, Athanasiou T. Does a skeletonized or pedicled left internal thoracic artery give the best graft patency? Interact Cardiovasc Thorac Surg 2010;10(1):97-104. [Crossref]
  • 12. Keeley SB. The skeletonized internal mammary artery. Ann Thorac Surg 1987;44(3):324-5. [Crossref]
  • 13. Hu X, Zhao Q. Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary artery bypass surgery for good quality grafts. Ann Thorac Surg 2011;92(1):48-58. [Crossref]
  • 14. Athanasiou T, Crossman MC, Asimakopoulos G, Ashok C, Weerasinghe A, Glenville B, et al. Should the internal thoracic artery be skeletonized? Ann Thorac Surg 2004;77(6):2238-46. [Crossref]
  • 15. Momin AU, Deshpande R, Potts J, El-Gamel A, Marrinan M, Omigie J, et al. Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting. Ann Thorac Surg 2005;80(5):1765-72. [Crossref]
  • 16. Svensson LG, Mumtaz MA, Blackstone EH, Feng J, Banbury M, Sabik J, et al. Does use of a right internal thoracic artery increase deep wound infection and risk after previous use of a left internal thoracic artery? J Thorac Cardiovasc Surg 2006;131(3):609-13. [Crossref]
  • 17. Kamiya H, Akhyari P, Martens A, Karck M, Haverich A, Lichtenberg A. Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: A randomized study. J Thorac Cardiovasc Surg 2008;135(1):32-7. [Crossref]
  • 18. Deo SV, Shah IK, Dunlay SM, Erwin P, Locker C, Altarabsheh S, et al. Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients. Ann Thorac Surg 2013;95(3):862-9. [Crossref]
  • 19. Taggart DP, Douglas D, Altman DG, Gray AM, Lees B, Gerry S, et al. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J 2010;31(20):2470-81. [Crossref]
  • 20. Rihal CS, Eagle KA, Mickel MC, Foster D, Sopko G, Gersh B. Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. Circulation 1995;91(1):46-53. [Crossref]
  • 21. Van Straten AH, Firanescu C, Soliman Hamad MA, Tan SH, Woorst FJ, Martens EJ, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: Comparison with a matched general population. Ann Thorac Surg 2010;89(2):414-20. [Crossref]
  • 22. Collison T, Smith JM, Engel AM. Peripheral vascular disease and outcomes following coronary artery bypass graft surgery. Arch Surg 2006;141(12):1214-8. [Crossref]
  • 23. Karthik S, Musleh G, Grayson AD, Keenan JM, Pullan DM, Dihmis W, et al. Coronary surgery in patients with peripheral vascular disease: Effect of avoiding cardiopulmonary bypass. Ann Thorac Surg 2004;77(4):1245-9. [Crossref]
  • 24. Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: A systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001;358(9285):870-5. [Crossref]
  • 25. Kurlansky PA, Traad EA, Dorman MJ, Galbut DL, Zucker M, Ebra G. Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. Ann Thorac Surg 2010;90(1):101-8. [Crossref]
  • 26. Gottlob R. Ascending arteriography and evaluation of aortographic pictures. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 1954;277(5):483-9. [Crossref]
  • 27. Hardman RL, Lopera JE, Cardan RA, Trimmer CK, Josephs SC. Common and rare collateral pathways in aortoiliac occlusive disease: A pictorial essay. AJR Am J Roentgenol 2011;197(3):519-24. [Crossref]
  • 28. Dietzek AM, Goldsmith J, Veith FJ, Sanchez LA, Gupta SK, Wengerter KR. Interruption of critical aortoiliac collateral circulation during nonvascular operations: A cause of acute limb-threatening ischemia. J Vasc Surg 1990;12(6):645-53. [Crossref]
  • 29. Yapici F, Tuygun AG, Tarhan IA, Yılmaz M, Tuygun AK, Yapıcı N, et al. Limb ischemia due to use of internal thoracic artery in coronary bypass. Asian Cardiovasc Thorac Ann 2002;10(3):254-5. [Crossref]
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Ayçe Özgen This is me 0000-0002-0985-3224

Publication Date December 1, 2022
Published in Issue Year 2022 Volume: 25 Issue: 3

Cite

Vancouver Özgen A. Should We Hesitate to Use Skeletonized Bilateral Internal Mammary Artery?. Koşuyolu Heart Journal. 2022;25(3):235-9.