[HSF] skeletons

[Michael Firstenberg]

Fact (I think/hope/believe):  patent LIMA-LAD provides the best  
option for long-term event free survival.

Question:  Which technique provides a patent LIMA-LAD in the most  
patients for the longest period of time
    If 1 technique is "easier" than the other - how many LIMA's are  
"not usable" or "sub-optimal" due to
     the differences in using 1 vs the other?
Again, are we looking at short-term benefits at the expense of long- 
term gains?
Does it really make a difference?  or is it just a function of which  
technique is "better" in a particular
    surgeon's hands?

michael


On Oct 17, 2006, at 8:39 AM, Donald Ross 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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