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J Thorac Cardiovasc Surg 2002;123:508-511
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Decreased sternal vascularity after internal thoracic artery harvesting resolves with time: An assessment with single photon emission computed tomography

From the Departments of Cardiovascular Surgery^a and Nuclear Medicine,^b The Edith Wolfson Medical Center, Holon (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Israel.

Received for publication April 9, 2001; revisions requested July 23, 2001; revisions received Aug 21, 2001; accepted for publication Aug 28, 2001. Address for reprints: Benjamin Medalion, MD, Department of Cardiovascular Surgery, The E. Wolfson Medical Center, Holon, 58100 Israel (E-mail: medalion{at}wolfson health.gov.il)

Objective: We sought to prospectively evaluate the long-term effect of left internal thoracic artery harvesting on sternal vascularity.
Methods: Twelve consecutive patients undergoing primary coronary artery bypass grafting were studied. In all patients a pedicled left internal thoracic artery was harvested. Each patient underwent a preoperative technetium-99m methylene diphosphonate bone scan with single photon emission computed tomography. The ratio of the mean counts per pixel for each side of the sternum was obtained. All patients had early repeat bone scans 6 ± 2.4 days postoperatively and late repeat bone scans 18.6 ± 3.5 months after the operation. Ratios of unilateral sternal uptakes were compared between the different scans. One patient died during follow-up and was excluded from the study.
Results: There was a significant decrease in flow to the left hemisternum in the early postoperative scan compared with that in the preoperative scan (P < .001). At late follow-up scans, flow to the left hemisternum had returned to normal (P = .119). Midterm clinical follow-up demonstrated 3 superficial wound infections. No musculoskeletal pain existed at the time of follow-up, but 3 patients had numbness or tingling at the skin area corresponding to the site from which the left internal thoracic artery was harvested.
Conclusions: Acute postoperative sternal ischemia caused by harvesting of a pedicled left internal thoracic artery is temporary and resolves with time.

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