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. 2013 Jan;8(1):48-53.
Epub 2013 Jan 8.

Impact of Intact Pleura during Left Internal Mammary Artery Harvesting on Clinical Outcome

Alireza Alizadeh Ghavidel  1 , Eskandar Noorizadeh, Hamidreza Pouraliakbar, Yalda Mirmesdagh, Saeid Hosseini, Behnam Asgari, Mahyar Gholamour Dehaki
Affiliations

Impact of Intact Pleura during Left Internal Mammary Artery Harvesting on Clinical Outcome

Alireza Alizadeh Ghavidel et al. J Tehran Heart Cent. 2013 Jan.

Abstract

Background: Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery (LIMA) harvesting.

Methods: Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 54, 46 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events.

Results: THE INCIDENCE OF POSTOPERATIVE PERICARDIAL EFFUSION WAS SIMILAR BETWEEN THE GROUPS, BUT THE INCIDENCE OF POSTOPERATIVE PULMONARY COMPLICATIONS SUCH AS PLEURAL EFFUSION (EXCEPT FOR MILD PLEURAL EFFUSION) ON THE SECOND (NO: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value < 0.001 and p value = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value < 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value = 0.002) were significantly higher in group A than those in group B.

Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.

Keywords: Coronary artery bypass; Pericardial effusion; Pleural effusion; Pulmonary atelectasis.

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Figures

Figure 1
Figure 1
Comparison of preoperative, early, and second and fifth postoperative days’ PO2 between Group A (opened pleura) and Group B (Closed pleura) PO2, Partial oxygen pressure
Figure 2
Figure 2
Comparison of preoperative early, and second and fifth postoperative days’ O2 saturation between Group A (opened pleura) and Group B (closed pleura)
Figure 3
Figure 3
Comparison of preoperative early, and second and fifth postoperative days’ PCo2 between Group A (opened pleura) and Group B (closed pleura) PCO2, Carbon dioxide partial pressure
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