Short term clinical and angiographic outcome after different techniques of left internal mammary artery harvesting for coronary revascularization

Abstract

Background: We examined the hypothesis that there is no difference in the short term clinical and angiographic outcome of skeletonized or pedicled left internal mammary artery (LIMA) used for revascularization of left anterior descending artery (LAD) at CABG surgery. Accordingly, our effort in this study was to find out difference between two harvesting technique of LIMA.

Methods: We studied 60 consecutive patients who underwent coronary artery bypass grafting, in which the LIMA was anastomosed to the left anterior descending artery. In 30 consecutive LIMAs were harvested as a pedicle (Group-P) and another 30 consecutive LIMAs were harvested as skeletonized graft (Group-S). Three diameters of the LIMA graft were measured quantitatively in postoperative angiograms performed 6 ± 1 month after the coronary artery bypass grafting; D1, at the origin from the subclavian artery; D2, at the level of the second intercostal space; and D3, just proximal to the anastomosis.

Results: Our study shows that, though complete skeletonization results in increased graft length 19.71 ± 1.77 cm in skeletonized group vs. 17.08 ± 0.71cm in pedicle group (p <0.001) and significantly less time required for harvesting in pedicle group; but similar incidence of superficial wound complications and PCP in both groups. Check coronary angiography showed the LIMA grafts to the LAD were all patent. There was no significant difference in diameter throughout the graft length except for increased diameter achievement in skeletonized group at anastomotic site (D3: 1.78 ± 0.21 mm vs. 1.66 ± 0.18 mm; p = 0.03). Conclusions: We conclude that skeletonized and pedicled LIMA showed a similar functional behavior, in-hospital results, postoperative profile and similar postoperative angiographic assessment. Apart from the need for longer conduits, there is no reason to prefer skeletonized to pedicle mammary grafts.