Changes in Sternal Blood Flow after Different Methods of Internal Thoracic Artery Harvesting

Abstract

Objective: The study was designed to assess the early changes in sternal perfusion after midline sternotomy and different (skeletonized versus semiskeletonized) techniques of internal thoracic artery (ITA) harvesting. Methods: The experiments were performed in the swine model. After midline sternotomy, ITA harvesting (skeletonized technique) was performed unilaterally in Group I (6 animals). The ITA and the internal thoracic vein (ITV) were harvested (semiskeletonized technique) in Group II (5 animals). The contralateral sternal half served as a control. Using a thermographic camera with a 0.06 °C sensitivity, sternal perfusion was assessed 2 and 5 hours after surgery. Results: Midline sternotomy alone did not affect sternal blood flow. A statistically significant (p < 0.05) reduction in perfusion of the involved sternal half in comparison to the control side was detected at 2 and 5 hours after surgery. The degree of perfusion deficit was not related to the harvesting technique. Conclusions: Skeletonized and semiskeletonized ITA harvesting techniques caused a similar acute reduction in sternal perfusion during the early postoperative period and this effect lasted for at least 5 hours.

Sternal blood flow - thermography - internal thoracic artery harvesting

References

• 1 Arnold M. The surgical anatomy of sternal blood supply.  J Thorac Cardiovasc Surg. 1972;  64 596-610
• 2 Lytle B W. Skeletonized internal thoracic artery grafts and wound complications.  J Thorac Cardiovasc Surg. 2001;  121 625-627
• 3 Peterson M D, Borger M A, Rao V, Peniston C M, Feindel C M. Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes.  J Thorac Cardiovasc Surg. 2003;  126 1314-1319
• 4 Lorberboym M, Medalion B, Bder O, Lockman J, Cohen N, Schachner A. et al . ^{99 m}Tc-MDP bone SPECT for the evaluation of sternal ischaemia following internal mammary artery dissection.  Nuclear Medicine Communications. 2002;  23 47-52
• 5 Knobloch K, Lichtenberg A, Pichlmaier M, Mertsching H, Krug A, Klima U. et al . Microcirculation of the sternum following harvesting of the left internal mammary artery.  Thorac Cardiovasc Surg. 2003;  51 255-259
• 6 Korbmacher B, Schmitt H H, Bauer G, Hoffmann M, Vosberg H, Simic O. et al . Change of sternal perfusion following preparation of the internal thoracic artery - a scintigraphical study.  Eur J Cardio-Thorac Surg. 2000;  17 58-62
• 7 Rivas L F, Hawkins T, Morritt G N, Behl R P, Griffin S C, Brown A H. Radiopharmaceutical uptake as a marker of sternal blood supply following internal mammary artery harvesting.  Cardiovasc Surg. 1994;  2 203-206
• 8 Seyfer A E, Schriver C D, Miller T R, Graeber G M. Sternal blood flow after median sternotomy and mobilization of the internal mammary arteries.  Surgery. 1988;  104 899-904
• 9 Lust R M, Kasagi Y, Morrison R F, Sun Y S, Austin H, Chitwood W R. Residual sternal ischemia following median sternotomy repair despite the retention of one intact mammary artery.  Circulation. 1988;  78 II-477
• 10 Bahn C H, Holloway G A. Effect of internal mammary artery mobilization on sternal blood flow.  Chest. 1990;  98 878-880
• 11 Green G E, Swistel D G, Castro J, Hillel Z, Thornton J. Sternal blood flow during mobilization of the internal thoracic arteries.  Ann Thorac Surg. 1993;  55 967-970
• 12 Love T J. Thermography as an indicator of blood perfusion.  Ann N Y Acad Sci. 1980;  335 429-437
• 13 Falk V, Walther T, Philippi A, Autschbach R, Krieger H, Dalichau H. et al . Thermal coronary angiography for intraoperative patency control of arterial and saphenous vein coronary artery bypass grafts: results in 370 patients.  J Card Surg. 1995;  10 147-160
• 14 Stefanadis C, Tsiamis E, Vaina S, Toutouzas K, Boudoulas H, Gialafos J. et al . Temperature of blood in the coronary sinus and right atrium in patients with and without coronary artery disease.  Am J Cardiol. 2004;  93 207-210
• 15 Robicsek F, Masters T N, Daugherty H K, Cook J W, Selle J G, Hess P J. et al . The value of thermography in the early diagnosis of postoperative sternal wound infections.  Thorac Cardiovasc Surg. 1984;  32 260-265
• 16 Stefanadis C, Toutouzas K, Vavuranakis M, Tsiamis E, Vaina S, Toutouzas P. New balloon-thermography catheter for in vivo temperature measurements in human coronary atherosclerotic plaques: a novel approach for thermography?.  Catheterization & Cardiovascular Interventions. 2003;  58 344-350
• 17 Parish M A, Asai T, Grossi E A, Esposito R, Galloway A C, Colvin S B. et al . The effects of different techniques on internal mammary artery harvesting on sternal blood flow.  J Thorac Cardiovasc Surg. 1992;  104 1303-1307
• 18 Robicsek F, Fokin A, Cook J, Bhatia D. Sternal instability after midline sternotomy.  Thorac Cardiovasc Surg. 2000;  48 1-8
• 19 Ueda T, Taniguchi S, Kawata T, Mizugughi K, Nakajima M, Yosioka A. Does skeletonization compromise the integrity of internal thoracic artery grafts?.  Ann Thorac Surg. 2003;  75 1429-1433
• 20 Cohen A J, Lockman J, Lorberboym M, Bder O, Cohen N, Medalion B. et al . Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the internal thoracic artery.  J Thorac Cardiovasc Surg. 1999;  118 496-502
• 21 Carrier M C, Grégoire J, Tronc F, Cartier R, Leclerc Y, Pelletier L-C. Effect of internal mammary artery dissection on sternal vascularization.  Ann Thorac Surg. 1992;  53 115-119