influence of intact pleura on postoperative respiratory dysfunction after coronary artery bypass grafting [CABG] using bilateral internal mammary arteries [BIMA]

ABSTRACT

Bilateral internal mammary artery harvesting for coronary artery bypass graft had shown to be superior compared to venous grafts in regard to cardiac events, however the major drawbacks from such technique is early postoperative complications; namely bleeding, wound infection [deep or superficial] and impairment of respiratory function. We tested the hypothesis of modifying the surgical technique when harvesting bilateral mammary arteries with maintaining pleural integrity [Npo group A n=25] and conventional technique with pleura opened [po group B n=25] and its effect on early postoperative complications. Patients in group A [Npo] had demonstrated more favorable early postoperative outcome compared to group B [po] evidenced by better PaO2/FiO2, dynamic spirometry function [FEV1 72.5% versus 59.9% of expected and FVC 64.5% versus 52.3% of expected], less morbidities [4 incidences versus 10 incidences], less postoperative bleeding [461 ml versus 570.8 ml] and better cough score. Meticulous harvesting of bilateral internal mammary artery with preservation of pleura could dramatically decrease early postoperative complications associated with such technique