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Ann Thorac Surg 2006;81:139-143
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Benefit of Partial Right-Bilateral Internal Thoracic Artery Harvesting in Patients at Risk of Sternal Wound Complications

Jacob Zeitani, MD a , * , Alfonso Penta de Peppo, MD b , Ruggero De Paulis, MD a , Paolo Nardi, MD a , Antonio Scafuri, MD a , Saverio Nardella, MD a , Luigi Chiariello, MD a

a Division of Cardiac Surgery, Tor Vergata University, Rome, Italy
b Second University of Naples, Naples, Italy

Accepted for publication June 8, 2005.

* Address correspondence to Dr Zeitani, Division of Cardiac Surgery, Tor Vergata University, Via Oxford 85, Rome 00133, Italy (Email: zeitani{at}hotmail.com).

BACKGROUND: Excellent long-term patency of the internal thoracic artery (ITA) graft promotes use of bilateral ITA bypass grafting; sternal devascularization, however, increases the risk of wound complications. We hypothesized that restricting right ITA (RITA) harvesting to a short proximal skeletonized segment (3 to 5 cm) would result in adequate residual blood supply to reduce that risk.

METHODS: Seventy-eight patients with numerous risk factors for wound complications underwent composite double ITA grafting, utilizing the RITA segment anastomosed to the left skeletonized ITA and to the obtuse marginal branch in Y fashion. Blood flow in the distal RITA was assessed by parasternal transthoracic Doppler ultrasonography. Comparisons were made with prospectively collected data of patients undergoing pedicled single (n = 160) or skeletonized bilateral ITA grafting (n = 143) during the same period.

RESULTS: Incidence of obesity, chronic obstructive pulmonary disease, diabetes, and peripheral vascular disease was higher in study patients. Postoperative Doppler ultrasonography detected reversed systolic dominant flow pattern. Wound complications occurred in 2 of 78 (2.6%) patients, compared with 14 of 143 (9.8%) after bilateral ITA (p = 0.04) and 8 of 160 (5%) after single ITA grafting (p = ns). Technique of bilateral ITA harvesting (partial right versus full length; odds ratio, 0.2; confidence interval: 0.04 to 0.9) and diabetes mellitus (odds ratio, 2.7; 95% confidence interval: 1.1 to 6.3) were independent predictors of wound complications in the entire series.

CONCLUSIONS: Substantial residual blood supply is detectable after partial RITA harvesting and may prevent wound complications in high-risk patients.




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Invited commentary
Ann. Thorac. Surg., January 1, 2006; 81(1): 144 - 144.
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