Impact of intact pleura during left internal mammary artery harvesting on clinical outcome

ABSTRACT

Pleurotomy during coronary artery bypass grafting [CABG] may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery [LIMA] harvesting. Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups group A [n = 48, 36 male and 12 female patients at a mean age of 56.5 +/- 11.2 years] underwent routine CABG and pleurotomy and group B [n = 54, 46 male and 8 female patients at a mean age of 55.4 +/- 10.3 year] had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. The incidence of postoperative pericardial effusion was similar between the groups, but the incidence of postoperative pulmonary complications such as pleural effusion [except for mildpleural effusion] on the second [no 10.4%, mild 41.7%, moderate 45.8% and severe 2.7% in group A versus no 42.6%, mild 44.4%, moderate 13%, and severe 0 in group B] and fifth postoperative days [no 27.1%, mild 33.3%, moderate 35.4%, and severe 4.2% in group A versus no 42.6%, mild 44.4%, moderate 13%, and severe 0 in group B] was significantly lower in group B [p value < 0.001 and p value = 0.007, respectively]. Also, the incidence of atelectasis [except for mild atelectasis] on the second [no 2.1%, mild 22.9%, moderate 72.9%, and severe 2.1% in group A versus no 9.2%, mild 59.3%, moderate 31.5%, and severe 0 in group B] and fifth postoperative days [no 22.9%, mild 39.6%, moderate 35.4%, and severe 2.1% in group A versus no 39.6%, mild 49.1%, moderate 11.3%, and severe 0 in group B] was significantly higher in group A [p value < 0.001 and p value = 0.004, respectively]. Postoperative partial oxygen pressure and 02 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A [p value = 0.017]. Amount of bleeding [p value = 0.008] and duration ofhospitalization [p value =0.002] were significantly higher in group A than those in group B. Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion