Modified Pericardial Closure to Protect Internal Mammary Artery Grafts in Coronary Artery Bypass

Abstract

Redo operations after coronary artery bypass surgery have been on the rise, and myocardial and graft injury during resternotomy a catastrophe. Closure of pericardium after a traditional midline incision may lead to graft distortion. In this report, we will describe a technique of pericardial closure and thymus coverage to protect bilateral internal mammary artery grafts from damage.

Key words

Pericardial closure - Coronary artery bypass - Internal mammary artery

References

• 1 Pick A W, Orszulak T A, Anderson B J. et al . Single versus bilateral internal mammary artery grafts: 10-year outcome analysis.  Ann Thorac Surg. 1997;  64 599-605
• 2 Dobell A RC, Jain A K. Catastrophic hemorrhage during redo sternotomy.  Ann Thorac Surg. 1984;  37 273-963
• 3 Rao V, Komeda M, Weisel R D, Cohen G, Borger M A, David T E. Should the pericardium be closed routinely after heart operation?.  Ann Thorac Surg. 1999;  67 484-488
• 4 Daughters G T, Frist W H, Alderman E L, Derby G C, Ingels N B, Miller D C. Effects of the pericardium on left ventricular diastolic filling and systolic performance early after cardiac operations.  J Thorac Cardiovasc Surg. 1992;  104 1084-1091
• 5 Angelini G D, Fraser A G, Koning M MG. et al . Adverse hemodynamic effects and echocardiographic consequences of pericardial closure soon after sternotomy and pericardiotomy.  Circulation. 1990;  82 (Suppl IV) IV397-406