The outcomes of Skeletonized and Pedicled Internal Thoracic Artery in Patients undergoing coronary artery bypass grafting: a randomized clinical study

Yousry A Shaheen; Mahmoud  Ahmad El-Shafiey; Mostafa Galal Hebishy; Ahmad  Sobhy Emara

doi:10.35810/ects.v2i1.101

Yousry A Shaheen Department of Cardiothoracic Surgery, Faculty of medicine, Benha University, Benha, Egypt
Mahmoud Ahmad El-Shafiey Department of Cardiothoracic Surgery, Faculty of medicine, Benha University, Benha, Egypt
Mostafa Galal Hebishy EL-Zaytoun specialized hospital, Cairo, Egypt
Ahmad Sobhy Emara Department of Cardiothoracic Surgery, Faculty of medicine, Benha University, Benha, Egypt

DOI: https://doi.org/10.35810/ects.v2i1.101

Keywords: Coronary bypass graft, Internal thoracic artery, Sternal healing

Abstract

Background: Internal thoracic artery became the cornerstone graft in coronary artery bypass grafting. This study aimed to investigate sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized versus pedicled internal thoracic artery.

Methods: 100 patients who underwent isolated CABG were divided into two groups; skeletonized internal thoracic artery (ITA) (50 patients) and pedicled internal thoracic artery (50 patients). The postoperative assessment was performed three months after surgery. Physical and radiological examinations were performed after surgery to assess sternal healing.

Results: There was no significant difference in patients’ demographics between groups. Skeletonized group had more diabetic patients (65% vs 44%; p= 0.016). There was no significant difference between the two groups regarding the number of grafts (2.72 ± 0.89 vs. 2.68 ± 0.90; skeletonized vs pedicled group; p= 0.84). Harvesting time was longer in the skeletonized group (55.69 ± 8.80 vs. 44.28 ± 6.95 minutes; p=0.09). Superficial wound infection occurred more frequently in the pedicled group (24% vs. 8%; p=0.03).

Conclusion: Skeletonization of the internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG compared to the pedicled technique. However, skeletonization of internal thoracic artery conduits prolongs the operation time and requires more surgical skills.