PURPOSE: Employing in situ left internal thoracic artery (LITA) as a arterial conduit is indicated to the patients undergoing coronary artery bypass grafting (CABG) procedure for long life expectancy. In this study to decrease the pulmonary complications after bypass operations, we aimed to investigate the effect of opening the pleural cavity while harvesting LITA in terms of postoperative respiratory functions.
METHODS: 320 patients who underwent elective CABG at our institute between March/2003 and September/2005 selected and retrospectively studied. The patients divided into two groups regarding opening left pleural cavity while harvesting LITA, as group I(n=160) patients undergoing LITA harvesting without opening pleural cavity and group II(n=160) patients with opening pleural cavity. We evaluated patients in terms of preoperative and postoperative respiratory functions such as: vital capacity(VC), forced expiratory volume in 1 second(FEV1), and residual volume(RV). In addition, we recorded duration of mechanical ventilation, length of intensive care unit (LOICU) stay, development of pneumothorax, atellectasis and pleural effusion.
RESULTS: In patients with opened thoracic cavity the value of FEV1(%) and RV(%) was significantly decreased on postoperative 5th day.(p<0,001)According to this results the value differences between preoperative and postoperative FEV1, FVC and RV were significantly higher in group II(p<0,001). The incidence of pleural effusions that needs to be drainage was significantly higher in group II versus group I on postoperative 5th day (Group I;1,25%, Group II;8,75%, p<0.002). And also the amount of the pleural effusion was significantly higher in opened thoracic cavity group.
CONCLUSION: After the results of the study, we recommend not opening the pleural cavity routinely in terms of long term respiratory functions but at the other hand, LAD-LITA is the gold standard bypass procedure in cardiac surgery and absolutely the graft must be prepared preciously.
CLINICAL IMPLICATIONS: We recommend not opening the pleural cavity routinely in terms of long term respiratory functions.
DISCLOSURE: Mehmet Ates, None.