Laugesen Sofie, Krasniqi Lytfi, Benhassen Leila Louise, Mortensen Poul Erik, Pallesen Peter Appel, Bak Søren, Kjelsen Bo Juel, Riber Lars Peter
Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.
Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark.
Interdiscip Cardiovasc Thorac Surg. 2024 May 2;38(5). doi: 10.1093/icvts/ivae102.
It is uncertain whether Thunderbeat has a place in harvesting the left internal mammary artery (LIMA) and whether skeletonization is superior to pedicle-harvested LIMA. Some investigations have shown improved flowrates in the skeletonized graft. The aim of this study was to compare 3 groups of harvesting techniques: Pedicled, surgical skeletonized and skeletonized with Thunderbeat in terms of flow rates in the LIMA and postoperative in-hospital outcomes.
Patients undergoing coronary artery bypass grafting with the LIMA to the anterior descending artery were randomized to pedicled (n = 56), surgical skeletonized (n = 55) and skeletonized with Thunderbeat (n = 54). Main outcomes were blood flow and pulsatility index in the graft.
No statistical difference between groups regarding flow in LIMA or pulsatility index. Similarly, no difference in postoperative bleeding or days of hospitalization. The duration of harvesting was faster for the pedicled technique compared with surgical skeletonized and skeletonized with Thunderbeat [mean total min: pedicled 20.2 min standard deviation (SD) ± 5.4; surgical skeletonized 28.6 min SD ± 8.7; skeletonized with Thunderbeat 28.3 min SD ± 9.11, P < 0.001]. No grafts discarded due to faulty harvesting and there was no graft failure within hospital stay.
We found no difference between the harvesting methods except for a significantly faster harvesting time with the pedicled technique. However, non-touch skeletonized LIMA harvesting with Thunderbeat seems to be an effective alternative to traditional surgical skeletonized LIMA. The future will reveal whether patency is harvesting dependent.
ClinicalTrials.gov Identifier: NCT05562908.
尚不确定“雷动”（Thunderbeat）在获取左乳内动脉（LIMA）时是否有一席之地，以及骨骼化技术是否优于带蒂获取的LIMA。一些研究表明，骨骼化移植物的血流速度有所提高。本研究的目的是比较三组获取技术：带蒂、手术骨骼化和使用“雷动”进行骨骼化，比较指标为LIMA的血流速度和术后住院结局。
接受LIMA至前降支冠状动脉搭桥术的患者被随机分为带蒂组（n = 56）、手术骨骼化组（n = 55）和使用“雷动”进行骨骼化组（n = 54）。主要结局指标为移植物中的血流和搏动指数。
三组在LIMA血流或搏动指数方面无统计学差异。同样，术后出血或住院天数也无差异。与手术骨骼化和使用“雷动”进行骨骼化相比，带蒂技术的获取时间更快[平均总分钟数：带蒂20.2分钟，标准差（SD）±5.4；手术骨骼化28.6分钟，SD±8.7；使用“雷动”进行骨骼化28.3分钟，SD±9.11，P < 0.001]。没有因获取失误而丢弃移植物，住院期间也没有移植物失败。
我们发现除带蒂技术的获取时间明显更快外，获取方法之间没有差异。然而，使用“雷动”进行非接触式骨骼化LIMA获取似乎是传统手术骨骼化LIMA的有效替代方法。未来将揭示通畅性是否取决于获取方式。
ClinicalTrials.gov标识符：NCT05562908。
