The effect of skeletonization of the left internal thoracic artery on rates of sternal wound infection : experience at queen alia heart institute

Abstract EN

Objectives: To study whether skeletonization of the internal thoracic artery has any beneficial effects on the rate of sternal wound infection after Coronary Artery Bypass Surgery and to compare this with the results of the classical pedicled form.

Methods: A total of 212 patients were reviewed between October 2005 and February 2006 and divided into two groups according to the method of harvesting the left internal thoracic artery.

Group I comprised 158 patients, 102 males and 56 females with a mean age of 59±2 years.

Group II comprised 54 patients, 41 males and 13 females with a mean age of 57±2 years.

In group I, the Left Internal Thoracic Artery was harvested in the classical pedicle form (preserving the vasa vasorum, venous drainage) using cautery and clips.

In group II another method of harvesting was adopted using forceps and scissors and depriving the Left Internal Thoracic Artery from all the accompanying structures.

Results: The overall rate of sternal wound infection was 9.5% in Group I and 3.7% in group II (P<0.05).In Group I, 10 males and five females were infected (males 9.8% and females8.9%) while in group II only two male patients were infected.

Conclusion: Harvesting the Left Internal Thoracic Artery in the skeletonized form takes longer time and is more difficult to do due to our developing learning curve; nonetheless it has a beneficial effect on decreasing the rate of sternal wound infection.

The overall outcome was improved but other issues such as the overall patency and post operative pain should be studied more thoroughly.