Background
The internal mammary artery is the vessel of choice for myocardial revascularisation
during coronary artery bypass grafting (CABG). Although it is possible to harvest
the left internal mammary artery (LIMA) without opening the left pleura, pleurotomy
is usually performed to provide adequate exposure and allow the placement of the LIMA
medial to the upper lobe, preventing any undue tension on the mammary pedicle. However,
the intact pleura technique may have a lower risk of postoperative pulmonary complications.
We aimed to study the effects of both procedures on pulmonary function and the incidence
of complications.
Method
One hundred patients with ischaemic heart disease indicated for CABG were included
and divided into two groups. The closed pleural technique group included 50 patients
with preservation of the pleural integrity during mammary harvesting. The open pleural
procedure group included 50 patients without preservation of pleural integrity. Spirometry
was done pre- and postoperatively in both groups and postoperative pulmonary complications
in both groups were recorded and analysed.
Results
Internal mammary harvesting with preservation of pleural integrity during CABG in
patients in the closed pleural procedure group showed significant improvement in forced
expiratory volume in the first second (FEV1%), forced vital capacity (FVC%), and FEV1/FVC
compared with the corresponding values in patients in the open pleural procedure group,
on day 5 postoperatively, at discharge, and at day 30. There were fewer complications
in preservation of pleural integrity with regard to lung atelectasis and pleural effusion,
which were significantly lower in patients in the open pleural procedure group.
Conclusions
Preservation of pleural integrity has beneficial effects on pulmonary function and
has fewer associated pulmonary complications.
Keywords
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Article info
Publication history
Published online: October 24, 2019
Accepted:
September 29,
2019
Received in revised form:
September 18,
2019
Received:
December 13,
2018
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
