Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: A randomized study

Kamiya, Hiroyuki; Akhyari, Payam; Martens, Andreas; Karck, Matthias; Haverich, Axel; Lichtenberg, Artur

doi:10.1016/j.jtcvs.2007.09.004

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 1 , Pages 32-37, January 2008

Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: A randomized study

Hiroyuki Kamiya, MD
- Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, Germany
Payam Akhyari, MD
- Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, Germany
Andreas Martens, MD
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Matthias Karck, MD
- Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, Germany
Axel Haverich, MD
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Artur Lichtenberg, MD
- Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, Germany
- Address for reprints: Artur Lichtenberg, MD, Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.

Received 5 April 2007; received in revised form 29 August 2007; accepted 11 September 2007.

Objective

In human patients the influence of skeletonized internal thoracic artery harvesting on the sternal microcirculation in the perioperative phase has not been well investigated.

Methods

Twenty-four consecutive male patients who were scheduled for isolated coronary artery bypass grafting were prospectively randomized into 2 groups. The left internal thoracic artery was harvested by using the skeletonized technique in group 1, and it was harvested with a pedicle in group 2. Superficial (2 mm) and deep (8 mm) tissue oxygen saturation and blood flow were measured presternally and retrosternally in the upper, middle, and lower sternal parts with a novel laser Doppler flowmetric and remission spectroscopic system (Oxygen-to-See; LEA Medizintechnik, Giessen, Germany).

Results

Presternal tissue oxygen saturation deteriorated at the upper and middle sternum, and presternal blood flow deteriorated at all measurement points after internal thoracic artery harvesting in both groups. Skeletonization had no advantage in maintaining presternal microcirculation. Retrosternal microcirculation also deteriorated at all measurement points after internal thoracic artery harvesting in both groups. However, the deterioration of the retrosternal microcirculation was significantly less in group 1 at the middle and lower sternum; values of oxygen saturation to the baseline were 86% ± 3.8% versus 60% ± 4.3% (P = .001) at 2-mm depth and 82% ± 4.2% versus 61% ± 6.1% (P = .009) at 8-mm depth at the middle sternum and 95% ± 3.2% versus 78% ± 1.3% (P = .001) at 2-mm depth and 94% ± 2.2% versus 78% ± 4.6% (P = .004) at 8-mm depth at the lower sternum in groups 1 and 2, respectively.

Conclusion

The damage of the tissue microcirculation in the middle and lower retrosternal area is significantly less after internal thoracic artery skeletonization compared with that after the pedicled internal thoracic artery harvesting technique.

CTSNet classification: 5, 23

Abbreviations and Acronyms: ITA, internal thoracic artery, LITA, left internal thoracic artery, So₂, oxygen saturation