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Ann Thorac Surg 1997;64:1221
© 1997 The Society of Thoracic Surgeons

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Correspondence

Effects of Different Methods of Internal Mammary Artery Harvesting

Halifax Infirmary, Rm 2265, Halifax NS B3H 3a7, Canada

To the Editor:

It is interesting to read the article by Matsumoto and associates titled "Effect of Different Methods of Internal Thoracic Artery Harvest on Pulmonary Function" [1]. As mentioned in the article, a controversy exists regarding the postoperative pulmonary effect of pleurotomy. We and others, in large series of patients, demonstrated that opening the pleura during harvesting of the internal thoracic artery does not have any significant clinical effect on the overall patient morbidity [2, 3]. Opening the pleura, however, increases the incidence of pleural effusion and atelectasis on the corresponding side because of the overflow of the mediastinal blood.

Doctor Matsumoto and colleagues did not comment in their study about the incidence or the degree of pleural effusion and atelectasis in spite of a higher number of pleurotomies in group 2 (standard internal thoracic artery harvesting). This per se could be responsible for the noticed postoperative pulmonary dysfunction rather than the internal thoracic artery harvesting technique. The difference between 84% and 77% in vital capacities appears small in spite of statistical significance (p < 0.05), which could be a reflection of the small sample size. The question here is: what is the clinical significance of this difference, and how much morbidity does it reflect?

The skeletonized vessel technique, at least theoretically, might help in protecting the sternal blood supply in comparison with the standard technique; however, it increases the risk of damaging the artery and risking the graft patency. Therefore it probably should be recommended only in the situations where the healing of the sternum is at higher risk, eg, bilateral internal mammary artery use in diabetic and obese patients.

References

1. Matsumoto M, Konishi Y, Miwa S, Minakata K. Effect of different methods of internal thoracic artery harvest on pulmonary function. Ann Thorac Surg 1997;63:653–5.
2. Ali MI, Lau P, Kinley E, Sanalla A. Opening the pleura during internal mammary artery harvesting: advantages and disadvantages. Can J Surg 1996;39:42–5.[Medline]
3. Fredinande PG, Beets G, Michel A, et al. Pulmonary function tests after different techniques for coronary bypass surgery. Intensive Care Med 1988;14:623–7.[Medline]

This Article 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): Idris M. Ali Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ali, I. M. Search for Related Content PubMed PubMed Citation Articles by Ali, I. M.