Shahinian Jasmin H, Cogliatti Lorena, Gahl Brigitta, Berdajs Denis, Grapow Martin, Eckstein Friedrich, Reuthebuch Oliver
Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland -
Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
J Cardiovasc Surg (Torino). 2019 Dec;60(6):742-748. doi: 10.23736/S0021-9509.19.10832-4. Epub 2019 Oct 4.
Our aim was to investigate the impact of the non-skeletonized (pedicled) versus the skeletonized left internal mammary (LIMA) harvesting technique on the postoperative sternal and parasternal skin perfusion in patients undergoing coronary artery bypass grafting (CABG), as compared to patients undergoing non-CABG heart surgery.
We included 142 patients who underwent non-bypass (N.=39) or CABG surgery (N.=103). CABG cases were differentiated according to the LIMA harvesting technique: skeletonized (N.=74) or non-skeletonized (N.=29). Parasternal and sternal skin perfusion measurements via a Laser Doppler Imaging tool were performed on the preoperative day and 5-7 days postoperatively, using a grid of 15 spatially segregated measurement points across the chest and normalization to a distinct reference point. Data were analyzed retrospectively.
In the CABG group, the non-skeletonized LIMA harvesting resulted in a near-significant (P=0.057, two-sided Student t-test, 95% CI -[0.111, 0.002]), and the skeletonized LIMA harvesting in a significant (P< 0.001, 95% CI [-0.096, -0.032]) post-surgical decrease of left-sided parasternal skin perfusion in arbitrary perfusion units (APU), as compared to right-sided parasternal skin perfusion. No corresponding differences were found for the non-bypass group (P=0.5, 95% CI [-0.065, 0.033]). The harvesting techniques did not yield significantly different post-surgical parasternal skin perfusion measures in the CABG group (P=0.6).
Measurement of parasternal skin perfusion using Laser Doppler Imaging is feasible. Both harvesting techniques resulted in a reduced parasternal/sternal skin perfusion upon removal of the internal mammary artery.
我们的目的是研究与接受非冠状动脉旁路移植术（CABG）的心脏手术患者相比，非骨骼化（带蒂）与骨骼化左乳内动脉（LIMA）获取技术对接受冠状动脉旁路移植术（CABG）患者术后胸骨和胸骨旁皮肤灌注的影响。
我们纳入了142例行非旁路手术（n = 39）或CABG手术（n = 103）的患者。CABG病例根据LIMA获取技术进行区分：骨骼化（n = 74）或非骨骼化（n = 29）。术前及术后5 - 7天，使用激光多普勒成像工具对胸骨旁和胸骨皮肤灌注进行测量，在胸部设置15个空间分隔的测量点网格，并将其归一化到一个明确的参考点。对数据进行回顾性分析。
在CABG组中，与右侧胸骨旁皮肤灌注相比，非骨骼化LIMA获取导致左侧胸骨旁皮肤灌注在任意灌注单位（APU）上术后近乎显著降低（P = 0.057，双侧Student t检验，95% CI -[0.111, 0.002]），而骨骼化LIMA获取导致显著降低（P < 0.001，95% CI [-0.096, -0.032]）。非旁路组未发现相应差异（P = 0.5，95% CI [-0.065, 0.033]）。CABG组中，两种获取技术术后胸骨旁皮肤灌注测量结果无显著差异（P = 0.6）。
使用激光多普勒成像测量胸骨旁皮肤灌注是可行的。两种获取技术在切除乳内动脉后均导致胸骨旁/胸骨皮肤灌注降低。
