Extrapleural harvesting of the internal thoracic artery – impact on early postoperative results and pulmonary function

Abstract

Introduction: The internal thoracic artery (ITA) has proven to be the best graft for surgical myocardial revascularization, especially in the configuration left ITA (LITA) to the anterior descending branch of left coronary artery (LAD). Its harvesting is usually accompanied by pleurotomy, followed by drainage tube placement into the pleural cavity, using the so called intrapleural method. Extrapleural technique for LITA harvesting is also practiced in many cardiac surgery centers and with this technique the pleura is left intact. Aim: The aim of our study was to investigate the impact of both techniques of LITA harvesting on lung function and incidence of postoperative complications early after operation. Materials and methods: We analyzed retrospectively data of 82 operated patients scheduled for surgical myocardial revascularization and meeting certain inclusion and exclusion criteria. The patients were divided into two groups depending on the way LITA was prepared. Lung parameters and incidence of surgical complications were registered in the early postoperative period until day 30. Results: The patients from both groups had similar preoperative characteristics and risk factors. Those with preserved pleura showed significantly better results of the studied pulmonary parameters and lower complications event rate during early postoperative follow-up. Conclusions: Maintaining the pleura integrity during LITA harvesting is beneficial for lung function and reduces the rate of complications in the early postoperative period.