[HSF] skeletons

Tea Acuff tacuff at swbell.net
Wed Oct 18 13:40:30 EDT 2006 

Not to be a nit but what is the definition of nonskeletonized mammary? Anything except except the technique of skeletalization used by these authors. Travel around and see what qualifies as a "pedicle", and you may be surprized at the variation.     One way of looking at this paper is that "skeletonized" is a "minimally invasive" method of IMA harvest. There is no benefit to the mammary itself except better length which may be helpful. We (or Dr. He) has shown more spasicity of the IMA distally. The flows appear similar.
Tea 


----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, October 17, 2006 5:30:20 PM
Subject: Re: [HSF] skeletons


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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