Changes in Sternal Blood Flow after Different Methods of Internal Thoracic Artery Harvesting

Abstract

Skeletonized and semiskeletonized ITA harvesting techniques caused a similar acute reduction in sternal perfusion during the early postoperative period and this effect lasted for at least 5 hours.

In-Hospital Outcomes of Pedicled Bilateral Internal Mammary Artery Use in Diabetic and Nondiabetic Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: Single-Surgeon, Single-Center Experience

“…Proponents of skeletonized BIMA harvest claim that the sternal blood supply is preserved with this technique, perhaps contributing to a lowering of the incidence of sternal wound complications in general and in diabetics in particular [Peterson 2003;De Paulis 2005;Nakano 2008]. This concept stems from animal studies, which have reported greater residual retrosternal blood flow after minimized retrosternal tissue mobilization with the skeletonization technique [Parish 1992;Fokin 2004], as well as from a small randomized study that used nuclear imaging [Boodhwani 2006]. This concept has recently been contradicted by Nishi and colleagues [2011].…”

Sternal force distribution during median sternotomy retraction

“…This is relevant because incipient sternal dehiscence is often related to the distal part. 34 In contrast, the force distribution in the CSR was completely different. Because of the curved profile, the sternum touches the retractor first at the middle, and the highest forces in the middle section of the retractor blades result from that geometric fact.…”

Chest Wall, Thymus, and Heart Transplant: Pushing the Boundary of Solid Organ and Vascularized Composite Allotransplantation

“…Our vascular perfusion study has profoundly impacted our surgical planning and reinforced the necessity of incorporating bilateral IMAs for perfusion of the allograft. Although multiple studies report decreased postoperative ipsilateral sternal perfusion following the use of the left IMA for coronary revascularization, [31][32][33] infectious complications usually manifest after bilateral IMAs are utilized. 35 This has led to the perception that one IMA can perfuse the ipsilateral and contralateral chest wall.…”