Comparison of left internal mammary harvesting techniques for coronary artery bypass grafting: A prospective study

Sarvesh Kumar, Vijayant Devenraj, Akshyaya Pradhan, Vivek Tewarson, Sushil Singh K, BB Kushwaha

Heart India 2018 6(3):90-96

Introduction: Left internal mammary artery (LIMA) is the most common arterial conduit used for patients undergoing coronary artery bypass grafting (CABG) surgery. Maintaining pleural integrity during harvesting has been documented to have better patient outcomes. Hence, we evaluated postoperative outcomes using two different LIMA harvesting techniques, one with intact pleura and other with pleura opened. Methods: In this prospective study, we recruited a total of 110 patients undergoing CABG. Based on the pleural being intact or opened, the patients were divided in two groups. In Group 1, LIMA was harvested with pleura intact (extra-pleural approach) while in Group 2, LIMA was harvested with pleura being opened (intrapleural / pleurotomy). The primary objective was to evaluate the impact on various post-operative parameters like total ventilatory time, mediastinal drainage, need for Blood transfusions, post operative deterioration of lung function , post operative pain scores and duration hospital stay. Results: Out of 110 patients undergoing CABG, LIMA was harvested by extra-pleural approach in sixty-six while in the rest forty-four pleurotomy was needed. The baseline demographic attributes of patients were similar in both groups. The post operative parameters such as ventilatory time, blood loss, need for blood transfusions, and prolonged hospital stay were found to be significantly higher in the group with intrapleural LIMA harvest technique (P <0.05). Pulmonary complications like pleural effusion, atelectasis were more frequent with in the intrapleural harvest as compared to extra-pleural harvest technique.(P <0.001). Post operative pain scores as evaluated by NRS scale were also significantly higher after intrapleural harvest (P <0.001). Conclusions: Harvesting of LIMA for CABG extrapleurally has significant post-operative benefits and faster recovery compared to pleurotomy and intraplueral approach.

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