EFFECT OF DIFFERENT METHODS OF INTERNAL THORACIC ARTERY HARVEST ON PULMONARY-FUNCTION

Background. In several clinical studies, internal thoracic artery (ITA ) grafting for myocardial revascularization has been identified as inc reasing the risk of postoperative pulmonary complications. This study was designed to determine whether the technique used to harvest the IT A has an effect on postoperative pulmonary function. Methods. Seventy- nine consecutive patients undergoing coronary artery bypass grafting u sing the left ITA were compared with patients undergoing coronary arte ry bypass grafting using saphenous vein grafts only. Two methods of IT A harvesting were used: (1) incision of the endothoracic fascia dissec ted off the ITA as a skeletonized vessel (group 1, n = 33) and (2) mob ilization of the ITA as a wide musculofascial pedicle (group 2, n = 46 ). Thirty-two patients underwent coronary artery bypass grafting using saphenous vein grafts only (group 3). Pulmonary function tests were p erformed between postoperative days 20 and 30. Results. The postoperat ive values of forced vital capacity were reduced in patients in all gr oups (p < 0.0001). The ratios of postoperative to preoperative forced vital capacity were 84% in group 1, 77% in group 5 and 84% in group 3. The reduction in group 2 was significant compared with group 1 (p < 0 .05) and group 3 (p < 0.05). Conclusions. Postoperative pulmonary dysf unction was significantly greater in patients who underwent wide muscu lofascial pedicle dissection of the ITA compared with skeletonization of the artery. Thus, of the two techniques, the latter may be the meth od of choice with regard to lowering the incidence of postoperative pu lmonary dysfunction. (C) 1997 by The Society of Thoracic Surgeons.