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Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy
Accepted for publication June 28, 2010.
* Address correspondence to Dr Mannacio, Via S. Domenico 62, Naples, 80127, Italy (Email: vitomannacio2{at}libero.it).
Background: The preferential harvesting technique of the internal mammary artery has been periodically debated. This randomized study evaluated the flow outcome of the skeletonized versus pedicled left internal mammary artery.
Methods: Two hundred patients undergoing surgery for left anterior descending coronary artery revascularization were enrolled and randomized to pedicled (n = 100) or skeletonized (n = 100) harvesting. Intraoperative baseline flow and post adenosine infusion into the left ventricle, hospital outcome, echocardiographic results, and troponin I leakage were analyzed. Noninvasive periodic evaluation of flow was carried out at rest and during intravenous adenosine infusion by transthoracic Doppler ultrasound, and was stratified according to the harvesting technique. Final angiographic evaluation was performed by 64-slice multidetector computed tomography.
Results: Skeletonized left internal mammary arteries demonstrated better flow capacity at rest and during adenosine recruitment perioperatively and at all time points of follow-up. Troponin I leakage was significantly higher in the pedicled group (59 vs 42, p = 0.02). Pedicled harvesting (hazard ratio [HR] 3.6, 95% confidence interval [CI] 2.5 to 6.9, p < 0.001); indexed left ventricular mass greater than 150 g/m2 (HR 4.6, 95% CI 3.1 to 7.5, p < 0.001); and baseline corrected thrombolysis in myocardial infarction frame count greater than 30 (HR 4.4, 95% CI, 3.8 to 7.2, p < 0.001) were the most powerful multivariable predictors of graft flow reserve less than 2.0. Postoperative echocardiographic results and clinical and angiographic outcomes were comparable between the two groups.
Conclusions: Skeletonization of the left internal mammary artery, beyond traditional proven advantages, provided significantly higher flow capacity and better graft flow reserve.
This article has been cited by other articles:
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  M. P. B. d. O. Sa, P. E. Ferraz, R. R. Escobar, F. P. Vasconcelos, A. A. B. Ferraz, D. M. Braile, and R. C. Lima Skeletonized versus pedicled internal thoracic artery and risk of sternal wound infection after coronary bypass surgery: meta-analysis and meta-regression of 4817 patients Interact CardioVasc Thorac Surg, June 1, 2013; 16(6): 849 - 857. [Abstract] [Full Text] [PDF]
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 V. Mannacio, L. Di Tommaso, V. De Amicis, F. Musumeci, and P. Stassano Serial Evaluation of Flow in Single or Arterial Y-Grafts to the Left Coronary Artery Ann. Thorac. Surg., November 1, 2011; 92(5): 1712 - 1718. [Abstract] [Full Text] [PDF]
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S. Shanmuganathan and O. Wendler Why Are ITA Free Flows Measured This Low? Ann. Thorac. Surg., September 1, 2011; 92(3): 1158 - 1159. [Full Text] [PDF]
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V. Mannacio, L. Di Tommaso, V. De Amicis, P. Stassano, and C. Vosa Reply Ann. Thorac. Surg., September 1, 2011; 92(3): 1159 - 1159. [Full Text] [PDF]
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T. Bove Invited Commentary Ann. Thorac. Surg., January 1, 2011; 91(1): 30 - 30. [Full Text] [PDF]
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