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Ann Thorac Surg 2007;84:822
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Division of Cardiothoracic Surgery, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 W Wisconsin Ave, Milwaukee, WI 53226-0099

(Email: nicolosi{at}mcw.edu).

Guizilini and colleagues [1] add to the body of literature debating the effects of opening the pleura during left internal thoracic artery (LITA) harvest. The authors demonstrate that LITA harvest in general is associated with impaired ventilatory mechanics and reduced oxygenation in the early postoperative period, but these adverse effects are exacerbated by opening the pleura during LITA harvest and placing a tube through the chest wall for drainage.

Although the article states that patients were allocated in a randomized, prospective fashion to either intact pleura (IP) or open pleura (OP) LITA harvest groups, it appears that assignment to OP was actually determined by incidental opening of the pleura during an otherwise intended IP harvest. Thus, most OP patients likely had minimal violation of the pleural envelope, suggesting that the major difference in technique between groups (and the basis for the observed differences in outcomes) was actually placement of the chest tube. This apparent impact of placing a chest tube make sense when one considers how much better patients feel after their chest tubes are removed. The difference in mean hospital stay between groups was also likely a factor of the chest tube, and probably not because of its effect on lung function, but because of occasional prolonged drainage.

Guizilini and colleagues [1] provide food for thought as we all continually fine-tune our operative techniques to maximize patient outcomes, including lengths of stay. If one prefers to open the pleura for LITA harvest, perhaps a softer drainage tube or an alternate route for tube exit (eg, subcostal, rather than through the chest wall) would be appropriate tactics to reduce the adverse effects of the drainage tube on pulmonary function. As we move toward less invasive (ie, nonsternotomy) approaches for CABG, we must be mindful of the effects of placing chest tubes, particularly because these newer approaches often entail bilateral chest drainage.

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1. Guizilini S, Gomes WJ, Faresin SM, et al. Influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting Ann Thorac Surg 2007;84:817-822.[Abstract/Free Full Text]

This Article Full Text (PDF) 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): Alfred Nicolosi Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nicolosi, A. Search for Related Content PubMed PubMed Citation Articles by Nicolosi, A. Related Collections Coronary disease Related Article