[HSF] skeletons

[Donald Ross]

Mchael,
Does your question imply that you don't have any skeletons in your  
chests?
I have been striping my imas bare for donkey's years and I assure you  
I would have heard from the crowing cardiologists if they were not  
patent.
Don
On 18/10/2006, at 8:30 AM, Michael Firstenberg wrote:

> 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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