This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Senol Yavuz Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yavuz, S. Search for Related Content PubMed PubMed Citation Articles by Yavuz, S. Related Collections Related Article

Bilateral internal thoracic artery harvesting: which harvesting technique is preferred?

Bursa Yüksek Ihtisas Education and Research Hospital, Bursa 16330, Turkey

Does bilateral internal thoracic artery harvest increase the risk of mediastinitis?

I read with great interest the paper by Toumpoulis et al. [1] that raised the question of whether bilateral internal thoracic artery (BITA) harvest for coronary artery bypass grafting (CABG) increases the risk of mediastinitis (also deep sternal infection). They stated that skeletonized BITA grafting can be performed with acceptable risk in all patients including higher risk group such as diabetics.

The single ITA has been used almost exclusively as a pedicled graft with construction of one or two (sequential) distal anastomoses. Nearly all publications report that bilateral pedicled ITA grafting increases the risk of mediastinitis. Therefore, in recent years there has been an increasing popularity of bilateral use of the skeletonized ITA for CABG. In order to gain the additional length, increase the number of arterial anastomoses and decrease the occurrence of deep sternal infections.

Skeletonized harvesting of the ITA together with a better glucose control in diabetic patients may significantly reduce the incidence of mediastinitis. I strongly believe that the ITA, if used bilaterally, should always take in the full skeletonized technique in obese and diabetic patients.

Skeletonized harvesting of the ITA can be performed either with small scissors and hemoclips or with an ultrasonic Harmonic scalpel [2, 3]. Higami et al. reported that the Harmonic scalpel causes minimal charring and thermal injury to the surrounding tissues of the ITA.

Apart from the study by Boodhwani et al. [4], up to date, there have been no randomized studies describing the role of skeletonized harvesting of the ITA in the prevention of mediastinitis. All these studies are observational findings. Previous observational published studies and Boodhwani et al.'s randomized, double-blinded, within-patient comparison study confirm that skeletonized harvesting of the ITA should be indicated in diabetic patients undergoing BITA grafting. Lastly, I believe that careful skeletonized harvesting of the ITA offers many advantages with an acceptable risk of complications compared to pedicled harvesting of the ITA. Hence, I agree with the authors that all cardiac surgeons should be trained efficiently with regard to skeletonized harvesting of the BITA.

	References

Top References

 

1. Toumpoulis IK, Theakos N, Dunning J. Does bilateral internal thoracic artery harvest increase the risk of mediastinitis? Interact CardioVasc Thorac Surg 2007; 6:787–792.[Abstract/Free Full Text]
2. De Paulis R, de Notaris S, Scaffa R, Nardella S, Zeitani J, Del Giudice C, De Peppo AP, Tomai F, Chiariello L. The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: the role of skeletonization. J Thorac Cardiovasc Surg 2005; 129:536–543.[Abstract/Free Full Text]
3. Higami T, Kozawa S, Asada T, Shida T, Ogawa K. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg 2000; 70:307–308.[Abstract/Free Full Text]
4. Boodhwani M, Lam BK, Nathan HJ, Mesana TG, Ruel M, Zeng W, Sellke FW, Rubens FD. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blinded, within-patient comparison. Circulation 2006; 114:766–773.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Senol Yavuz Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yavuz, S. Search for Related Content PubMed PubMed Citation Articles by Yavuz, S. Related Collections Related Article