Ann Thorac Surg 1998;66:986
© 1998 The Society of Thoracic Surgeons
Jacob Bergsland, MDa,
Tomas A. Salerno, MDa
a State University of New York at Buffalo and The CGF Health System, The Buffalo General Hospital, 100 High St, Buffalo, NY 14203, USA
To the Editor
Avulsion of the left internal mammary artery (LIMA) after minimally invasive coronary artery bypass grafting is a new entity that, to our knowledge, has not been previously reported. Coronary artery bypass grafting performed via the conventional technique of median sternotomy with or without cardiopulmonary bypass is not associated with this complication. One may therefore postulate that it is the technique of harvesting the LIMA, how high the LIMA is taken down, pericarditis fixing the LIMA pedicle, or other factors such as the one described by Ohtsuka that may be operative. Interference with the LIMA as a result of pulmonary motion is another possibility, although we would have thought that, with the number of LIMAs dissected daily and the fact that sometimes the LIMA is rather short, this potentially lethal complication would have already been reported in the literature. Certainly vigorous coughing, early extubation, mobilization, and resumption of normal activities early after operation may all potentially be contributing etiologic factors in LIMA avulsion. As we learn about this new operation, however, it is important to report any and all complications, so that the surgeon may prevent them. Doctor Ohtsuka has provided us with a new look at this potentially lethal complication. Although thoracoscopy may be beneficial, full harvesting of LIMA can be done today using the direct approach with specialized retractors.