Different methods to treat injured pleural following off-pump coronary artery bypass grafting using an internal mammary artery: A randomised controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Lin ,  KONG Qingyu , ZHANG Jianqun , CHI Liqun , XIAO Wei , CHEN Xinliang , ZHAN Xianghong

Department of Cardiaovascular Surgery, Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

KONG Qingyu, Email: kongqingyu@126.com

Keywords：

Coronary atherosclerotic heart disease; off-pump coronary artery bypass grafting; chest tube; pulmonary function

DOI：

10.7507/1007-4848.201609068

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveThe pleural injury caused by harvesting internal mammary artery (LIMA) can significantly increase the possibility of early pleural effusion after off-pump coronary artery bypass grafting (OPCABG). We compared the differences in pleural effusion, pain severity, and early lung function in different treatments to find the optimal strategy.MethodsA total of 300 patients receiving OPCABG using LIMA with left pleural lesion were selected (176 males and 124 females, mean age of 63.1±8.7 years). After bypass surgery, patients with pleural rupture were randomly divided into three groups: group A (n=100) received a pericardial drainage tube and a left chest tube inserted from the midline (subxyphoid); group B (n=100) had a pericardial drainage tube and a tube placed in the sixth intercostal space at the midaxillary line; group C (n=100) with the broken pleura sutured, had a pericardial drainage tube and a mediastinal drainage tube inserted. All patients underwent pulmonary function testing and arterial blood gas analysis on postoperative days (PODs) 5. The three methods were analyzed and evaluated.ResultsTotal drainage: group B (852±285 ml)>group C (811±272 ml)>group A (703±226 ml); there was no significant difference between the group B and group C, but they were statistically different from the group A (P<0 05="" patients="" with="" pleural="" effusion="" after="" removal="" of="" drainage="" tubes:="" group="" a="" 13="" patients="">group B (7 patients)>group C (3 patients), and there was significant difference among the three groups (P<0 05="" pain="" sensation="" the="" day="" after="" extubation:="" group="" b="" 2="" 4="" 0="" 8="" 3="" 8="" 0="" 9="">group A (1.9±0.7, 3.3±0.8)>group C (1.1±0.6, 2.5±0.8), there was significant difference among the three groups (P<0 05="" pain="" sensationon="" on="" postoperative="" days="" 5:="" group="" b="" 0="" 3="" 0="" 2="" 0="" 6="" 0="" 5="">group A (0.3±0.3, 0.5±0.4)>group C (0.2±0.2, 0.5±0.3), and there was no significant difference among the three groups. Vital capacity on postoperative days 5: there was no significant difference between the group B and group C, and both groups were greater than group A (P<0.05). There was no difference in FEV1 and PCO₂ among the three groups. Group C was better than group A in PO₂ on postoperative day 5 (P<0.05).ConclusionSuturing the broken pleura during the operation can not only reduce the degree of postoperative pain but also have less pleural effusion and better pulmonary function. It can be used as the preferred method.

Citation： LIANG Lin, KONG Qingyu, ZHANG Jianqun, CHI Liqun, XIAO Wei, CHEN Xinliang, ZHAN Xianghong. Different methods to treat injured pleural following off-pump coronary artery bypass grafting using an internal mammary artery: A randomised controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 423-429. doi: 10.7507/1007-4848.201609068 Copy

1.	Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med, 1986, 314(1): 1-6.
2.	Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2004, 110(14): e340-437.
3.	Berrizbeitia LD, Tessler S, Jacobowitz IJ, et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics: comparison of internal mammary and saphenous vein bypass grafts. Chest, 1989, 96(4): 873-876.
4.	Muellera XM, Tinguelya F, Tevaearaia HT, et al. Impact of duration of chest tube drainage on pain after cardiac surgery. Eur J Cardiothorac Surg, 2000, 18(5): 570-574.
5.	Symreng T, Gomez MN, Rossi N. Intrapleural bupivacaine versus saline after thoracotomy on pain and lung function: adouble-blind study. J Cardiothorac Anesth, 1989, 3(2): 144-149.
6.	Christensen MC, Dziewior F, Kempel A, et al. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth, 2012, 26(1): 46-51.
7.	Guizilini S, Gomes WJ, Faresin SM, et al. Evaluation of pulmonary function in patients following on-and off-pump coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2005, 20(3): 310-316.
8.	Vargas FS, Cukier A, Terra-Filho M, et al. Relationship between pleural changes after myocardial revascularization and pulmonary mechanics. Chest, 1992, 102(5): 1333-1336.
9.	Vargas FS, Terra-Filho M, Hueb W, et al. Pulmonary function after coronary artery bypass surgery. Respir Med, 1997, 91(3): 629-633.
10.	Andreasen JJ, Sørensen GV, Abrahamsen ER, et al. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg, 2016, 49(1): 288-292.
11.	Mueller XM, Tinguely F, Tevaearai HT, et al. Pain pattern and left internal mammary artery grafting. Ann Thorac Surg, 2000, 70(6): 2045-2049.
12.	Moore R, Follette D, Berkoff H. Poststernotomy fractures and pain management in open cardiac surgery. Chest, 1994, 106(5): 1339-1342.
13.	Singh NP, Vargas FS, Cukier A, et al. Arterial blood gases after coronary bypass surgery. Chest, 1992, 102(5): 1337-1341.
14.	Sick H, Oberling F, Guerbaoni M. Vascularization of the human sternum. Arch Anat Histol Embryol, 1974, 57(2): 197-220.
15.	Tulla H, Takala J, Alhava E, et al. Respiratory changes after open-heart surgery. Intensive Care Med, 1991, 17(6): 365-369.
16.	Milgrom LB, Brooks JA, Qi R, et al. Pain levels experienced with activities after cardiac urgery. Am J Crit Care, 2004, 13(2): 116-125.
17.	Craig DB. Postoperative recovery of pulmonary function. Anesth Analg, 1981, 60(1): 46-52.
18.	Cancio ASA, Guizilini S, Bolzan DW, et al. Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial. Rev Bras Cir Cardiovasc, 2012, 27(1): 103-109.
19.	Voigt L, Paice JA, Pouliot JA. Standardized pain flow sheet: impact on patient-reported pain experiences after cardiovascular surgery. Am J Crit Care, 1995, 4(4): 308-313.
20.	Hagl C, Harringer W, Gohrbandt B. Site of pleural drain insertion and early postoperative pulmonary function following coronary artery bypass grafting with internal mammary artery. Chest, 1999, 115(3): 757-761.

1. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med, 1986, 314(1): 1-6.
2. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2004, 110(14): e340-437.
3. Berrizbeitia LD, Tessler S, Jacobowitz IJ, et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics: comparison of internal mammary and saphenous vein bypass grafts. Chest, 1989, 96(4): 873-876.
4. Muellera XM, Tinguelya F, Tevaearaia HT, et al. Impact of duration of chest tube drainage on pain after cardiac surgery. Eur J Cardiothorac Surg, 2000, 18(5): 570-574.
5. Symreng T, Gomez MN, Rossi N. Intrapleural bupivacaine versus saline after thoracotomy on pain and lung function: adouble-blind study. J Cardiothorac Anesth, 1989, 3(2): 144-149.
6. Christensen MC, Dziewior F, Kempel A, et al. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth, 2012, 26(1): 46-51.
7. Guizilini S, Gomes WJ, Faresin SM, et al. Evaluation of pulmonary function in patients following on-and off-pump coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2005, 20(3): 310-316.
8. Vargas FS, Cukier A, Terra-Filho M, et al. Relationship between pleural changes after myocardial revascularization and pulmonary mechanics. Chest, 1992, 102(5): 1333-1336.
9. Vargas FS, Terra-Filho M, Hueb W, et al. Pulmonary function after coronary artery bypass surgery. Respir Med, 1997, 91(3): 629-633.
10. Andreasen JJ, Sørensen GV, Abrahamsen ER, et al. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg, 2016, 49(1): 288-292.
11. Mueller XM, Tinguely F, Tevaearai HT, et al. Pain pattern and left internal mammary artery grafting. Ann Thorac Surg, 2000, 70(6): 2045-2049.
12. Moore R, Follette D, Berkoff H. Poststernotomy fractures and pain management in open cardiac surgery. Chest, 1994, 106(5): 1339-1342.
13. Singh NP, Vargas FS, Cukier A, et al. Arterial blood gases after coronary bypass surgery. Chest, 1992, 102(5): 1337-1341.
14. Sick H, Oberling F, Guerbaoni M. Vascularization of the human sternum. Arch Anat Histol Embryol, 1974, 57(2): 197-220.
15. Tulla H, Takala J, Alhava E, et al. Respiratory changes after open-heart surgery. Intensive Care Med, 1991, 17(6): 365-369.
16. Milgrom LB, Brooks JA, Qi R, et al. Pain levels experienced with activities after cardiac urgery. Am J Crit Care, 2004, 13(2): 116-125.
17. Craig DB. Postoperative recovery of pulmonary function. Anesth Analg, 1981, 60(1): 46-52.
18. Cancio ASA, Guizilini S, Bolzan DW, et al. Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial. Rev Bras Cir Cardiovasc, 2012, 27(1): 103-109.
19. Voigt L, Paice JA, Pouliot JA. Standardized pain flow sheet: impact on patient-reported pain experiences after cardiovascular surgery. Am J Crit Care, 1995, 4(4): 308-313.
20. Hagl C, Harringer W, Gohrbandt B. Site of pleural drain insertion and early postoperative pulmonary function following coronary artery bypass grafting with internal mammary artery. Chest, 1999, 115(3): 757-761.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Different methods to treat injured pleural following off-pump coronary artery bypass grafting using an internal mammary artery: A randomised controlled trial

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content