HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bonacchi, M. Articles by Sani, G. Search for Related Content PubMed PubMed Citation Articles by Bonacchi, M. Articles by Sani, G. Related Collections Lung - other Coronary disease

Eur J Cardiothorac Surg 2001;19:827-833
© 2001 Elsevier Science NL

Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura

^a Cattedra of Cardiac Surgery, University of Florence, Florence, Italy
^b IRCCS NEUROMED, Via Atinense N.18, 86077(ISERNIA), Pozzilli, Italy

Received 15 January 2001; received in revised form 26 February 2001; accepted 19 March 2001.

Corresponding author. Cardiochirurgia, University Hospital of Florence ‘Careggi’, Viale Morgagni, 85-50134 Firenze, Italy. Tel: +39-3389855782; fax: +39-554277458
e-mail: mbonacchi{at}hotmail.com

Objective: To evaluate the role of intact pleurae regarding the postoperative respiratory functional status in patients undergoing coronary revascularization employing both internal mammary arteries (IMAs), according to the pedunculated or skeletonized technique (SKT) with opened or intact pleurae. Materials and methods: Using both IMAs, 299 patients underwent elective coronary revascularization. They were randomized and divided into group I (n=82, undergoing IMA harvesting according to the SKT without opening the pleurae); group II (n=186, undergoing IMA harvesting according the pedunculated technique with open pleurae); and group III (n=31, undergoing IMA harvesting according the SKT with incidentally opened pleurae). There were no differences regarding the preoperative patient characteristics and the anaesthetic and surgical management. Results: There were two deaths in group I versus seven in group II and one in group III (P=ns). The number of total arterial myocardial revascularization and arterial composite grafts was significantly higher in groups I and III than in group II, (P<0.001 and P<0.005, respectively). The incidence of postoperative complications was similar between groups. Blood loss of >1000 ml was significantly higher in group II than group I (P<0.028); but the incidence of re-thoracotomy and blood transfusion was similar between groups. The mechanical ventilation time was significantly higher in groups II and III versus group I (P<0.018 and P<0.02, respectively). The incidence of prolonged ventilation (>24 h), pleural effusion, thoracocentesis and atelectasis, resulted in being significantly higher in group II than group I. The incidence of thoracocentesis was significantly higher in group III than group I. The pain score and analgesic requirements at 1–12 h after awakening were significantly higher in groups II and III versus group I, becoming similar after the chest tubes were removed. PaO₂ was significantly higher, and PaCO₂ and FiO₂ were significantly lower in group I than groups II and III at 1 and 4 h before extubation and at 1 and 4 h after extubation. PaO₂ and PaCO₂ became similar between groups at the 5th postoperative day. Conclusions: According to our results, we may conclude that pleural integrity has beneficial effects on the respiratory functional status after coronary revascularization using both IMAs. A meticulous and more careful IMA harvesting approach significantly reduces the postoperative morbidity regarding the pulmonary functional status, and as a consequence, reduces the hospital costs.

Key Words: Bilateral internal mammary artery • Coronary revascularization • Respiratory dysfunction

This article has been cited by other articles:

				M. Malinowski, M. A. Deja, K. S. Golba, T. Roleder, J. Biernat, and S. Wos Perivascular tissue of internal thoracic artery releases potent nitric oxide and prostacyclin-independent anticontractile factor Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 225 - 231. [Abstract] [Full Text] [PDF]

				S. J. Durham and J. P. Gold Late Complications of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 535 - 548. [Full Text]

				S. Guizilini, W. J. Gomes, S. M. Faresin, D. W. Bolzan, E. Buffolo, A. C. Carvalho, and A. A.V. De Paola Influence of Pleurotomy on Pulmonary Function After Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., September 1, 2007; 84(3): 817 - 822. [Abstract] [Full Text] [PDF]

				M. Bonacchi, E. Prifti, M. Maiani, G. Giunti, and M. Leacche Skeletonized bilateral internal mammary arteries for non-elective surgical revascularization in unstable angina Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 120 - 126. [Abstract] [Full Text] [PDF]

				M. Wheatcroft, V. Shrivastava, B. Nyawo, A. Rostron, and J. Dunning Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications? Interactive CardioVascular and Thoracic Surgery, April 1, 2005; 4(2): 143 - 146. [Abstract] [Full Text] [PDF]

				M Bonacchi, F Battaglia, E Prifti, M Leacche, N S Nathan, G Sani, and G Popoff Early and late outcome of skeletonised bilateral internal mammary arteries anastomosed to the left coronary system Heart, February 1, 2005; 91(2): 195 - 202. [Abstract] [Full Text] [PDF]

				R. Wynne and M. Botti Postoperative Pulmonary Dysfunction in Adults After Cardiac Surgery With Cardiopulmonary Bypass: Clinical Significance and Implications for Practice Am. J. Crit. Care., September 1, 2004; 13(5): 384 - 393. [Abstract] [Full Text] [PDF]

				C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]

				T. Athanasiou, M.-C. Crossman, G. Asimakopoulos, A. Cherian, A. Weerasinghe, B. Glenville, and R. Casula Should the internal thoracic artery be skeletonized? Ann. Thorac. Surg., June 1, 2004; 77(6): 2238 - 2246. [Abstract] [Full Text] [PDF]

				M. Gaudino, C. Trani, F. Glieca, M. A. Mazzari, S. Rigattieri, G. Nasso, F. Alessandrini, G. Schiavoni, and G. Possati Early vasoreactive profile of skeletonized versus pedicled internal thoracic artery grafts J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 638 - 641. [Abstract] [Full Text] [PDF]

				M. Bonacchi, E. Prifti, G. Giunti, and G. Sani Retrocaval right internal mammary artery for left ventricular marginal arteries grafting Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 952 - 952. [Full Text] [PDF]

				M. Bonacchi, E. Prifti, G. Giunti, G. Frati, and G. Sani Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study Ann. Thorac. Surg., February 1, 2002; 73(2): 460 - 465. [Abstract] [Full Text] [PDF]

				P. Totaro, C. Fucci, and G. Minzioni Preserved pleura space integrity and respiratory dysfunction after coronary surgery Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 1067 - 1068. [Full Text] [PDF]

				M. Bonacchi, E. Prifti, G. Giunti, and G. Sani Reply to Totaro et al. Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 1069 - 1070. [Full Text] [PDF]