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The Annals of Thoracic Surgery, Vol 53, 115-119, Copyright © 1992 by The Society of Thoracic Surgeons
M Carrier, J Gregoire, F Tronc, R Cartier, Y Leclerc and LC Pelletier
Internal mammary artery (IMA) dissection may cause sternal
devascularization and ischemia resulting in sternal wound complication. To
evaluate the effect of median sternotomy and IMA dissection on sternal
vascular supply, sternal bone tomography was performed 7 days and 1 month
after cardiac operation in 67 patients. Seventeen nondiabetic patients had
single IMA grafts, 18 had double IMA grafts, and 12 had only saphenous vein
grafts or valve replacement. Twenty diabetic patients were studied after
any one of these operations. Seven patients were restudied 1 month after
the operation. Sternal technetium- 99m-methylene diphosphate tomography was
performed. The sternum was visualized and focal zones of hypoactivity
represented sternal hypoperfusion. The ratio of hypoactivity area over
total sternal area was calculated for every patient. After median
sternotomy without single or double IMA grafts, the averaged hypoperfusion
ratio was 4% +/- 1% compared with 13% +/- 3% after single IMA grafts and
24% +/- 6% after double IMA grafts (p less than 0.0001). Diabetic patients
without IMA, with single IMA, and with double IMAs showed hypoperfusion
areas of 5% +/- 3%, 15% +/- 5%, and 23% +/- 9%, respectively, a result
similar to that of nondiabetic patients. One month after operation the
hypoperfusion area decreased to 2% +/- 2% (p less than 0.05) in restudied
patients. Our results indicate that IMA dissection causes a significant
although partial and temporary sternal ischemia, which is more severe after
double IMA than single IMA mobilization and which may be incriminated in
the development of sternal wound infection. This vascularization defect was
not greater among patients with diabetes mellitus.
ARTICLES
Effect of internal mammary artery dissection on sternal vascularization
Department of Surgery, University of Montreal, Quebec, Canada.
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