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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1303-1307, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MA Parish, T Asai, EA Grossi, R Esposito, AC Galloway, SB Colvin and FC Spencer
We investigated chest wall blood flow in a canine model to determine if the
technique used to harvest the mammary artery has a differential effect on
residual chest wall blood flow. Eight dogs underwent bilateral internal
mammary artery mobilization; one artery was harvested as a pedicle and the
other was harvested as a skeletonized vessel. Residual blood flow to the
chest wall distribution of each artery was measured with radioactive
microspheres. Chest wall blood flow was significantly decreased from
preharvest levels after internal mammary artery mobilization regardless of
the technique used. Tissue blood flows decreased to 46.9%, 22.1%, and 41.2%
of baseline values for the manubrium (p < 0.01), sternum (p < 0.001),
and ribs (p < 0.05), respectively. Residual sternal blood flow on the
side of the skeletonized vessel was significantly greater than on the side
of the pedicle graft (2.60 +/- 0.68 versus 1.27 +/- 0.27 cm3/min/100 gm, p
< 0.001). We conclude that minimization of tissue mobilization during
internal mammary artery harvesting may reduce sternal devascularization.
This finding may have clinical significance with respect to lowering the
incidence of sternal wound complications in coronary bypass surgery using
the internal mammary artery as a bypass conduit.
ARTICLES
The effects of different techniques of internal mammary artery harvesting on sternal blood flow
Department of Surgery, New York University Medical Center, New York 10016.
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