Skeletonized versus Pedicle Left Internal Mammary Artery in Coronary Artery Bypass Grafting: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FANGQin ,  GUTian-xiang , LIUBo , SHIEn-yi , ZHANGYu-hai , YULei

Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

GUTian-xiang, Email: cmugtx@sina.com

Keywords：

Coronary artery bypass grafting; Skeletonized left internal mammary artery; Coronary atherosclerotic heart disease

DOI：

10.7507/1007-4848.20150092

Video：

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Objective To explore the effect of skeletonized left internal mammary artery (LIMA) in coronary artery bypass grafting (CABG). Methods A total of 122 patients who underwent pure CABG were recruited in the study in the First Affiliated Hospital of China Medical University between January and April 2013. There were 77 males and 45 females with age of 41-76(62.8±10.5) years. They were randomly assigned to received CABG with skeletonized LIMAs (group A, 60 patients) or pedicle LIMAs (the group B, 62 patients) by random digital table. LIMAs were all anastomosised to the left anterior descending artery. Results There was one patient failure in harvesting LIMA process in the group A and B respectively, and they were changed to saphenous vein grafts and excluded from the criteria. There were 2 and 3 patients of postoperative myocardial infarction in the group A and in the group B respectively, with incidence rate of 3.4% and 4.9% respectively (P > 0.05). One patient died in each group during hospitalization with hospital mortality rates of 1.7% and 1.6% respectively (P > 0.05). Complications such as mediastinal infection occurred zero and one patient in the group A and in the group B respectively (P > 0.05). LIMA harvesting time of the group A was statistically longer than that of the group B (30.7±7.2 min vs. 17.2±5.6 min, P < 0.05). In six months of follow-up after surgery, coronary CT showed patency rate of LIMA in the group A and in the group B was 96.8% and 100.0% respectively (P > 0.05). Conclusion The recent effect of skeletonized LIMA as graft material in CABG is satisfactory.

Citation： FANGQin, GUTian-xiang, LIUBo, SHIEn-yi, ZHANGYu-hai, YULei. Skeletonized versus Pedicle Left Internal Mammary Artery in Coronary Artery Bypass Grafting: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 332-336. doi: 10.7507/1007-4848.20150092 Copy

1.	Raja SG, Haider Z, Zaman H.Skeletonized bilateral internal mammary arteries for total arterial myocardial revascularization.Heart Lung Circ, 2004, 13(4):395-398.
2.	张尔永, 石应康, 蒙炜, 等.骨骼化乳内动脉在冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志, 2007, 14(6):415-417.
3.	Matsa M, Paz Y, Gurevitch J, et al.Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus.J Thorac Cardiovasc Surg, 2001, 121(4):668-674.
4.	Raja SG.Skeletonized bilateral internal thoracic arteries in patients with diabetes:additional advantages and concerns.J Thorac Cardiovasc Surg, 2004, 127(6):1856-1857.
5.	Kinoshita T, Asai T, Suzuki T, et al.Off-pump bilateral skeletonized internal thoracic artery grafting in elderly patients.Ann Thorac Surg, 2012, 93(2):531-536.
6.	Nezić DG, Knezević AM, Cirković MV, et al.The dilemma of skeletonized internal thoracic artery sequential bypass versus proximal pedicled in situ internalthoracic artery plus coronary-coronary free internal thoracic artery bypass for multiple lesions of the left anteriordescending coronary artery.J Thorac Cardiovasc Surg, 2004, 127(6):1810-1812.
7.	Parsa CJ, Shaw LK, Rankin JS, et al.Twenty-five-year outcomes after multiple internal thoracic artery bypass.J Thorac Cardiovasc Surg, 2013, 145(4):970-975.
8.	Onorati F, Esposito A, Pezzo F, et al.Hospital outcome analysis after different techniques of left internal mammary grafts harves-ting.Ann Thorac Surg, 2007, 84(6):1912-1919.
9.	Saso S, James D, Vecht JA, et al.Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternalwound infection.Ann Thorac Surg, 2010, 89(2):661-670.
10.	Kinoshita T, Asai T, Nishimura O, et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patientswith diabetes.Ann Thorac Surg, 2010, 90(4):1173-1179.
11.	Mannacio V, Di Tommaso L, De Amicis V, et al.Randomized flow capacity comparison of skeletonized and pedicled left internal mammary artery.Ann Thorac Surg, 2011, 91(1):24-30.
12.	Calafiore AM, Vitolla G, Iaco AL, et al.Bilateral internal mammary artery grafting:midterm results of pedicled vs.skeletonised conduits.Ann Thorac Surg, 1999, 67(6):1637-1642.
13.	Bical OM, Khoury W, Fromes Y, et al.Routine use of bilateral skeletonized internal thoracicartery grafts in middle-aged diabetic patients.Ann Thorac Surg, 2004, 78(6):2050-2053.
14.	Takami Y, Ina H.Effects of skeletonization on intraoperative flow and anastomosis diameter of internal thoracic arteries in coronary artery bypass grafting.Ann Thorac Surg, 2002, 73(5):1441-1445.
15.	Sauvage LR, Rosenfeld JG, Roby PV, et al.Internal thoracic artery grafts for the entire heart at a mean of 12 years.Ann Thorac Surg, 2003, 75(2):501-504.
16.	Hirose H, Amano A.Safe bilateral use of skeletonized internal thoracic artery in patients with diabetes.J Thorac Cardiovasc Surg, 2004, 127(5):1534-1535.
17.	Kim KB, Cho KR, Chang WI, et al.Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass:early result of Y versus in situ grafts.Ann Thorac Surg, 2002, 74(4):1371-1376.
18.	Raja SG, Dreyfus GD.Internal thoracic artery:to skeletonize or not to skeletonize?Ann Thorac Surg, 2005, 79(5):1805-1811.
19.	Momin AU, Deshpande R, Potts J, et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg, 2005, 80(5):1765-1772.
20.	Vassiliades TA Jr, Cosgriff N, Denham A, et al.Superiority of using bipolar radiofrequency energy for internal mammary artery harvesting.Ann Thorac Surg, 2007, 83(4):1508-1512.
21.	Hu X, Zhao Q.Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary arterybypass surgery for good quality grafts.Ann Thorac Surg, 2011, 92(1):48-58.
22.	李儒正, 天野篤, 廣瀬仁, 等.超声刀在骨骼化动脉血管桥采取中的应用.中国心血管病研究杂志, 2006, 4(6):429-431.
23.	Pektok E, Cikirikcioglu M, Engin C, et al.Does harvesting of an internal thoracic artery with an ultrasonic scalpel have an effect on sternal perfusion?J Thorac Cardiovasc Surg, 2007, 134(2):442-447.

1. Raja SG, Haider Z, Zaman H.Skeletonized bilateral internal mammary arteries for total arterial myocardial revascularization.Heart Lung Circ, 2004, 13(4):395-398.
2. 张尔永, 石应康, 蒙炜, 等.骨骼化乳内动脉在冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志, 2007, 14(6):415-417.
3. Matsa M, Paz Y, Gurevitch J, et al.Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus.J Thorac Cardiovasc Surg, 2001, 121(4):668-674.
4. Raja SG.Skeletonized bilateral internal thoracic arteries in patients with diabetes:additional advantages and concerns.J Thorac Cardiovasc Surg, 2004, 127(6):1856-1857.
5. Kinoshita T, Asai T, Suzuki T, et al.Off-pump bilateral skeletonized internal thoracic artery grafting in elderly patients.Ann Thorac Surg, 2012, 93(2):531-536.
6. Nezić DG, Knezević AM, Cirković MV, et al.The dilemma of skeletonized internal thoracic artery sequential bypass versus proximal pedicled in situ internalthoracic artery plus coronary-coronary free internal thoracic artery bypass for multiple lesions of the left anteriordescending coronary artery.J Thorac Cardiovasc Surg, 2004, 127(6):1810-1812.
7. Parsa CJ, Shaw LK, Rankin JS, et al.Twenty-five-year outcomes after multiple internal thoracic artery bypass.J Thorac Cardiovasc Surg, 2013, 145(4):970-975.
8. Onorati F, Esposito A, Pezzo F, et al.Hospital outcome analysis after different techniques of left internal mammary grafts harves-ting.Ann Thorac Surg, 2007, 84(6):1912-1919.
9. Saso S, James D, Vecht JA, et al.Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternalwound infection.Ann Thorac Surg, 2010, 89(2):661-670.
10. Kinoshita T, Asai T, Nishimura O, et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patientswith diabetes.Ann Thorac Surg, 2010, 90(4):1173-1179.
11. Mannacio V, Di Tommaso L, De Amicis V, et al.Randomized flow capacity comparison of skeletonized and pedicled left internal mammary artery.Ann Thorac Surg, 2011, 91(1):24-30.
12. Calafiore AM, Vitolla G, Iaco AL, et al.Bilateral internal mammary artery grafting:midterm results of pedicled vs.skeletonised conduits.Ann Thorac Surg, 1999, 67(6):1637-1642.
13. Bical OM, Khoury W, Fromes Y, et al.Routine use of bilateral skeletonized internal thoracicartery grafts in middle-aged diabetic patients.Ann Thorac Surg, 2004, 78(6):2050-2053.
14. Takami Y, Ina H.Effects of skeletonization on intraoperative flow and anastomosis diameter of internal thoracic arteries in coronary artery bypass grafting.Ann Thorac Surg, 2002, 73(5):1441-1445.
15. Sauvage LR, Rosenfeld JG, Roby PV, et al.Internal thoracic artery grafts for the entire heart at a mean of 12 years.Ann Thorac Surg, 2003, 75(2):501-504.
16. Hirose H, Amano A.Safe bilateral use of skeletonized internal thoracic artery in patients with diabetes.J Thorac Cardiovasc Surg, 2004, 127(5):1534-1535.
17. Kim KB, Cho KR, Chang WI, et al.Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass:early result of Y versus in situ grafts.Ann Thorac Surg, 2002, 74(4):1371-1376.
18. Raja SG, Dreyfus GD.Internal thoracic artery:to skeletonize or not to skeletonize?Ann Thorac Surg, 2005, 79(5):1805-1811.
19. Momin AU, Deshpande R, Potts J, et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg, 2005, 80(5):1765-1772.
20. Vassiliades TA Jr, Cosgriff N, Denham A, et al.Superiority of using bipolar radiofrequency energy for internal mammary artery harvesting.Ann Thorac Surg, 2007, 83(4):1508-1512.
21. Hu X, Zhao Q.Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary arterybypass surgery for good quality grafts.Ann Thorac Surg, 2011, 92(1):48-58.
22. 李儒正, 天野篤, 廣瀬仁, 等.超声刀在骨骼化动脉血管桥采取中的应用.中国心血管病研究杂志, 2006, 4(6):429-431.
23. Pektok E, Cikirikcioglu M, Engin C, et al.Does harvesting of an internal thoracic artery with an ultrasonic scalpel have an effect on sternal perfusion?J Thorac Cardiovasc Surg, 2007, 134(2):442-447.

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Skeletonized versus Pedicle Left Internal Mammary Artery in Coronary Artery Bypass Grafting: A Randomized Controlled Trial

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