[HSF] skeletons

[Donald Ross]

Skeletonized Internal Thoracic Artery Harvest Reduces Pain
and Dysesthesia and Improves Sternal Perfusion After
Coronary Artery Bypass Surgery
A Randomized, Double-Blind, Within-Patient Comparison
Munir Boodhwani, MD, MMSc; B. Khanh Lam, MD; Howard J. Nathan, MD;  
Thierry G. Mesana, MD, PhD;
Marc Ruel, MD, MPH; Wanzhen Zeng, MD; Frank W. Sellke, MD; Fraser D.  
Rubens, MD, MSc
Background—Observational studies suggest that skeletonization of the  
internal thoracic artery (ITA) can improve conduit
flow and length and reduce deep sternal infections and postoperative  
pain. We performed a randomized, double-blind,
within-patient comparison of skeletonized and nonskeletonized ITAs in  
patients undergoing coronary surgery.
Methods and Results—Patients (n 48) undergoing bilateral ITA harvest  
were randomized to receive 1 skeletonized and
1 nonskeletonized ITA. Intraoperatively, 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, at 2 weeks, and at a 3-month
follow-up. Sternal perfusion was assessed with nuclear imaging (n 7).  
Skeletonization required longer ITA harvest
times (27 1 versus 24 1 minutes; P 0.04). There was a trend toward  
increased ITA length in the skeletonized group
(18.2 0.3 versus 17.7 0.3 cm; P 0.09). In situ ITA flow was lower in  
skeletonized arteries (7.4 0.9 versus 10.1 1.0
mL/min; P 0.01) and increased significantly after ITA division and  
papaverine application. Postanastomotic flows
were similar between groups. Skeletonization was associated with  
decreased pain at the 3-month follow-up and a
reduction in major sensory deficits at the 4-week and 3-month (17%  
versus 50%; P 0.002) follow-ups. Baseline
adjusted sternal perfusion was significantly greater by 17 6% (P  
0.03) on the skeletonized side.
Conclusions—Skeletonization results in reduced postoperative 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
after CABG. (Circulation. 2006;114:766-773.)

On 17/10/2006, at 7:38 PM, Nasser F. Abou'Seada wrote:

> Dear Don
> Paper did not pass
>
> NFA
>
>> -----Original Message-----
>> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
>> bounces at lists.hsforum.com] On Behalf Of Donald Ross
>> Sent: Tuesday, October 17, 2006 5:06 AM
>> To: OpenHeart-L at lists.hsforum.com
>> Subject: Re: [HSF] skeletons
>>
>> This is  nice paper supporting all the benefits of the naked ima.
>> with some science instead of a gut feeling.
>>
>>
>
>
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