The Effects Of Internal Mammary Artery Harvesting Techniques OnPulmonary Functions

Yıl 2011, Cilt: 14 Sayı: 3, 76 - 78, 01.03.2010

Kemal Uzun Hakan Kara Davut Uğurlu

Öz

Background: Although it impairs the pulmonary functions, internal mammary artery harvesting with pedunculated or skeletonized technique has been proved to have better long-term outcomes. Even if there is no full consent, some reports insisting on the advantages of skeletonized LIMA harvesting to decrease pulmonary side effect. Our aim is to compare the postoperative respiratory functional status in patients using these two techniques. Method: Totally 80 patients were included in the study and were divided into two groups; in group P (n=40) LIMA was dissected as a pedunculated graft and in group S (n=40) LIMA was prepared as a skeletonized graft. Pulmonary functions were evaluated on the 6th and 7th postoperative days and were compared between the two groups. Results: Forced expiratory volume in the 1st second (FEV1) and forced vital capacity (FVC) were the measured data. The decrease in FVC was more prominent in group P (p

Anahtar Kelimeler

Internal mammary artery, pulmonary function tests.

İnternal Mammaryan Arter Hazırlama Tekniklerinin Akciğer Fonksiyon Testlerine Etkileri

Öz

Giriş: Sol internal mammaryan arter (LİMA), kullanılması akciğer fonksiyonlarında bozulmalara yol açmakla birlikte, ister pediküllü ister skeletonize hazırlansın koroner bypass ameliyatlarında geç dönem açıklık oranları en iyi olan grefttir. Henüz kesin görüş oluşmamakla birlikte skeletonizasyon tekniğinin akciğerler üzerine olan yan etkileri azalttığını iddia eden yayınlar vardır. Amacımız akciğer fonksiyon testlerinde bu tekniklere bağlı olarak bir fark oluşup oluşmadığını ortaya koymaktır. Yöntem: Çalışmaya LİMA'sı skeletonize olarak çıkarılan ardışık 40 hasta (grup S) ve pediküllü olarak çıkarılan yine ardışık 40 hasta (grup P) olmak üzere toplam 80 hasta dahil edildi. Preoperatif ve postoperatif (6. veya 7. gün) solunum fonksiyon testleri karşılaştırıldı. Bulgular: Solunum fonksiyon testlerinde 1. saniyedeki zorlu expiratuvar volüm (FEV1) ve zorlu vital kapasite (FVC) değerleri ölçüldü. FVC'nin Grup P'de grup S'ye göre daha fazla azaldığı tespit edildi (p

Anahtar Kelimeler

İnternal mammaryan arter, Solunum fonksiyon testleri

Kaynakça

• 1. Calafiore AM, Vitolla G, Iaco AL, Fino C, Di Giammarco G, Marchesani F, et al. Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits. Ann Thorac Surg 1999;67:1637-42.
• 2. Cohen AJ, Moore P, Jones C, Miner TJ, Carter WR, Zurcher RP, et al. Effect of internal mammary harvest on postoperative pain and pulmonary function. Ann Thorac Surg 1993;56:1107-9.
• 3. Bonacchi M, Prifti E, Giunti G, Salicaa A, Fratib G, Sani G. Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura. Eur J Cardiothorac Surg 2001;19:827-33.
• 4. Matsumoto M, Konishi Y, Miwa S, Minakata K. Effect of different methods of internal thoracic artery harvest on pulmonary function. Ann Thorac Surg 1997;63:653-5.
• 5. Shapira N, Zabatino SM, Ahmed S, Murphy DM, Sullivan D, Lemole GM. Determinants of pulmonary function in patients undergoing coronary bypass operation. Ann Thorac Surg 1990;50:268-73.
• 6. Greinecker GW, Hakimi MY, Rinne T, Buhl R, Matheis G, Martens S, et al. Effect of internal thoracic artery preparation on blood loss, lung function, and pain. Ann Thorac Surg 1999;67:1078-82.
• 7. Burgess GE, Cooper JR, Marino RJ, Peuler MJ, Mills NL, Ochsner JL, et al. Pulmonary effect of pleurotomy during and after coronary artery bypass with internal mammary artery versus saphenous vein grafts. J Thorac Cardiovasc Surg 1978; 76: 230-4.
• 8. Ömeroğlu SN, Uzun K, Mansuroğlu D, Ardal H, Rabus MB, Kirali K, et al. The effect of pleural integrity on respiratory function in coronary artery bypass surgery. Turkish J Thorac Cardiovasc Surg 2004;12:71-5.
• 9. Bar-El Y, Gilboa B, Unger N, Pud D, Eisenberg G. Skeletonized versus pedicled internal mammary artery: impact of surgical technique on post CABG surgery pain. Eur J Cardiothorac Surg 2005;27:1065-9.
• 10. Peterson MD, Borger MA, Rao V, Peniston CM, Feindel CM. Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. J Thorac Cardiovasc Surg 2003;126:1314-9.