Comparison of the Mammary Harvesting Technique

University Hospital Ostrava

Status: Completed

Conditions: Ischemic Heart Disease

Treatments: Procedure: The mammary artery harvesting by the pedicle technique; Procedure: No intervention; Procedure: The mammary harvesting using the skeletonization technique

Study type: Observational

Funder types: Other

Identifiers

NCT06464354

KCHC-01-mammary artery

SGS25/LF/2023 (Other Grant/Funding Number)

Details and patient eligibility

About

The skeletonization technique of left internal artery (LIMA) harvesting is reported as more spar-ing to the vascular supply of the sternum. Some studies report a greater length and greater flow of the graft additionally. The aim of our study was to measure the difference in post-op sternal blood supply compared to the pedicle harvesting technique and to measure the length and flow of the LIMA graft.

Full description

A total of 90 patients were examined in a prospective randomized study. In 60 patients referred for coronary artery bypass grafting (CABG), LIMA was harvested, one-half (n=30) skeletonized, and one-half (n=30) with a pedicle. Thirty patients operated via sternotomy without LIMA harvesting (other procedures, for instance, valve surgery) were the control group. In patients undergoing LIMA harvest, harvest duration, graft length, and graft free flow were measured at defined arterial pressure. In all patients, the sternal blood flow was examined by active dynamic thermography (DIRT): first preoperatively and on 4th postoperative day. During this, the time of spontaneous rewarming of the skin surface after the application of a cold stimulus was measured in the caudal part of the sternum. The difference between postoperative and preoperative time was calculated and compared between groups.

Enrollment: 90 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Elective cardiac surgery procedure via median sternotomy
• The left mammary artery (LIMA) harvesting for coronary bypass planned as a part of the operation - Group 1 and 2
• Other cardiac surgery procedures without the LIMA harvesting (valve surgery for instance) - Control group
• Signing of the informed consent

Exclusion criteria

• Emergent surgery
• Re-operation
• Re-sternotomy
• Thoracotomy approach
• Harvesting of both mammary arteries (BIMA)
• Endocarditis
• Ongoing non-cardiac infection
• Fever
• Circulatory failure
• Ongoing administration of catecholamines to patient
• Unsigned informed consent

Trial design

90 participants in 3 patient groups

LIMA - pedicle

Treatment:

Procedure: The mammary artery harvesting by the pedicle technique

LIMA - skeletonised

Treatment:

Procedure: The mammary harvesting using the skeletonization technique

Control group - LIMA not harvested

Treatment:

Procedure: No intervention