[HSF] skeletons

[Michael Firstenberg]

This paper is up for grabs on our journal club tomorrow, will let you know
what everyone thinks

michael


On 10/17/06, Donald Ross <donross at bigpond.com> wrote:
>
> 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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