POST CABG SURGERY PAIN WITH THE USE OF SKELETONIZED VERSUS PEDICLED TECHNIQUE OF INTERNAL THORACIC ARTERY HARVESTING

Abstract

Dear Prof. Hafizullah, we read the interesting article by Asad Khan and colleageentitle “POST CABG SURGERY PAIN WITH THE USE OF SKELETONIZED VERSUSPEDICLED TECHNIQUE OF INTERNAL THORACIC ARTERYHARVESTING”.Coronary artery bypass grafting (CABG) remains the goldstandard for the treatment of left main coronary artery disease and multi-vesseldiseases. Left internal mammary artery (LIMA) graft to the left anterior 1descending (LAD) artery has been shown to be the most important factor forsurvival and minimization of cardiac events in any patient undergoing coronaryartery bypass grafting. There are two common methods to harvest IMAs: 2skeletonization and pediculation. The method of skeletonization, originallydescribed in 1987 by Keeley.3Skeletonization of the IMAs has been proposed as a solution for many problemsrelated to the IMA harvest. Recent evidence suggests that skeletonization of theleft internal mammary artery (LIMA) can improve the flow and length of the flow,reduce deep sternal infections and postoperative pain.4We have conducted a similar study on 84 patients, after the inclusion andexclusion criteria were applied, 60 isolated CABG cases were studied. In the Sgroup (n = 30), harvested LIMA was performed according to skeletonizationtechnique, and in group P (n = 30), the pedicled technique was used Patients'demographic information and cardiovascular risk factors are recorded in table 1.Mean (± SD) age of the study participants was 63.9 (± 8.9) and 62.9 (± 9.7) inthe skeletonized and pedicled groups. As the table shows, there was nostatistically significant difference between the groups regarding age, gender,cardiovascular risk factors, number of grafts, cross clamp time, and pomp time.As illustrated in table 2 (showing early mean bleeding volume, and mean earlyand midterm postoperative pain scores), there were no significant differencesbetween the two groups in the early and mid-termpain scores (postoperative andafter one year of follow-up). However, there was a significant difference in LIMAlength between the groups (17.96±0.50 vs. 17.27±0.33, p<0.001).

Our study did not have a large sample size. Nevertheless, all theoperations are carried out by the same surgeon and the sametechnique at one single center, reducing operation technique andskills bias. In addition, potential detrimental factors to the studywere eliminated as far as possible since the two groups were matched for age, gender, cardiovascular risks and coagulationconditions. In conclusion, given the increased conduit length andreduced early post-operative pain in patients in the skeletonizationtechnique, this technique can be preferred over the pedicledtechnique.