Does intact pleura during internal mammary artery harvesting decreases pleuropulmonary complications?

ABSTRACT

To evaluate the effects on postoperative pulmonary function of pleural integrity versus opened pleura, in patients who receive a left internal mammary artery graft. Randomized control trial. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from June 2009 to Feb 2010. The study was conducted on 62 patients who underwent elective coronary artery bypass grafting. The patients were divided into 2 groups Group A consisted of patients who underwent internal mammary artery harvesting with opened pleura [n=31] while Group B consisted of patients having internal mammary artery harvested with intact pleura [n=31]. To monitor pleuro-pulmonary complications, chest radiography was performed routinely 1 day before operation and on the 2nd, 4th and 6th postoperative days. The preoperative, after extubation, and 1st postoperative day values of partial oxygen pressure [PaO2], partial carbon dioxide pressure [PaCO2], oxygen [O2] saturation and haematocrit were recorded for comparison. The effect of intact pleura on IMA traction was also recorded by serial cardiac enzymes measurement and electrocardiography in the immediate postoperative period. Pleural effusion occurred more often in patients of Group A [35.5% versus 12.9%] which was statistically significant [P 0.038]. However, no significant differences were recorded in postoperative respiratory complications. Reoperation for postoperative bleeding and tamponade was done in 6.5% and 3.2% of cases in Group B respectively but none Group A; however it was not statistically significant [P 0.076]. The mean postoperative hospital stay was 7.84 days for Group A and 7.58 days for Group B. Pleural integrity during IMA harvesting decreases pleural effusion. Although, no significant differences were recorded in postoperative lung complications, intact pleural technique of IMA harvesting is recommended because of the added advantage of decreasa rate of pleural effusion