How to harvest the left internal mammary artery-a randomized controlled trial.

Autor:	Laugesen S; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.; Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark., Krasniqi L; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.; Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark., Benhassen LL; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark., Mortensen PE; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark., Pallesen PA; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark., Bak S; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark., Kjelsen BJ; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark., Riber LP; Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.; Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark.
Jazyk:	angličtina
Zdroj:	Interdisciplinary cardiovascular and thoracic surgery [Interdiscip Cardiovasc Thorac Surg] 2024 May 02; Vol. 38 (5).
DOI:	10.1093/icvts/ivae102
Abstrakt:	Objectives: It is uncertain whether Thunderbeat has a place in harvesting the left internal mammary artery (LIMA) and whether skeletonization is superior to pedicle-harvested LIMA. Some investigations have shown improved flowrates in the skeletonized graft. The aim of this study was to compare 3 groups of harvesting techniques: Pedicled, surgical skeletonized and skeletonized with Thunderbeat in terms of flow rates in the LIMA and postoperative in-hospital outcomes. Methods: Patients undergoing coronary artery bypass grafting with the LIMA to the anterior descending artery were randomized to pedicled (n = 56), surgical skeletonized (n = 55) and skeletonized with Thunderbeat (n = 54). Main outcomes were blood flow and pulsatility index in the graft. Results: No statistical difference between groups regarding flow in LIMA or pulsatility index. Similarly, no difference in postoperative bleeding or days of hospitalization. The duration of harvesting was faster for the pedicled technique compared with surgical skeletonized and skeletonized with Thunderbeat [mean total min: pedicled 20.2 min standard deviation (SD) ± 5.4; surgical skeletonized 28.6 min SD ± 8.7; skeletonized with Thunderbeat 28.3 min SD ± 9.11, P < 0.001]. No grafts discarded due to faulty harvesting and there was no graft failure within hospital stay. Conclusions: We found no difference between the harvesting methods except for a significantly faster harvesting time with the pedicled technique. However, non-touch skeletonized LIMA harvesting with Thunderbeat seems to be an effective alternative to traditional surgical skeletonized LIMA. The future will reveal whether patency is harvesting dependent. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT05562908. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
Databáze:	MEDLINE
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