Abstract 3124: Skeletonized Internal Thoracic Artery Harvest Reduces Pain And Dysesthesia And Improves Sternal Perfusion Following Coronary Artery Bypass Surgery: A Randomized, Double-Blinded, Within-Patient Comparison
Background Observational studies suggest that skeletonization of the internal thoracic artery (ITA) can improve conduit flow and length, reduce deep sternal infections and post-operative pain. We performed a randomized, double-blinded, within-patient comparison of skeletonized versus non-skeletonized ITAs in patients undergoing coronary surgery.
Methods Patients (n=48) undergoing bilateral ITA harvest were randomized to receive one skeletonized and one non-skeletonized ITA. Intra-operatively, ITA flow was assessed directly and with a Doppler flow probe, before and after topical application of papaverine. ITA harvest time and conduit length were recorded. A blinded assessment of pain (visual analog scale) and dysesthesia (physical examination) was performed at discharge, 2 weeks, and 3 months follow-up. Sternal perfusion was assessed using nuclear imaging (n=7).
Results Skeletonization required longer ITA harvest times (27±1 vs. 24±1 minutes, p=0.04). There was a trend towards increased ITA length in the skeletonized group (18.2±0.3 vs. 17.7±0.3 cm, p=0.09). In-situ ITA flow was lower in skeletonized arteries (7.4±0.9 vs. 10.1±1.0 ml/min, p=0.01) and increased significantly following ITA division and papaverine application. Post-anastomotic flows were similar between groups. Skeletonization was associated with decreased pain at 3-month follow-up and a reduction in major sensory deficits at 4 week and 3 month (17% vs. 50%, p=0.002) follow-up. Baseline adjusted sternal perfusion was significantly greater by 17±6% (p=0.03) on the skeletonized side.
Conclusions Skeletonization results in reduced post-operative pain and dysesthesia and increased sternal perfusion at follow-up but does not produce increased conduit flow. ITA skeletonization may be a strategy for reducing morbidity following CABG.