A randomized comparison of flow characteristics of semiskeletonized and pedicled internal thoracic artery preparations in coronary artery bypass

BACKGROUND: Harvesting the internal thoracic artery (ITA) with semiskeletonization is an alternative technique between conventional wide pedicle and skeletonization. It is almost as simple as pedicle harvesting; however, it is supposed to provide the advantage of graft flow and length. Since the heart is unique being the only organ which is perfused during diastole, for comparing the intraoperative graft flow characteristics of semiskeletonization and pedicle technique, we used diastolic filling (DF) using transit-time flow measurement as a primary result. The objective of this study is to compare if semiskeletonized ITA has a greater effect on the intraoperative DF of graft flow versus conventional pedicled ITA in coronary artery bypass. METHODS: Between July 2015 and May 2016, a prospective evaluation of 60 consecutive patients undergoing coronary artery bypass grafting for left anterior descending artery revascularization were randomized to having semiskeletonized (n = 30) or conventional pedicled (n = 30) ITA graft harvested by the same surgeon. Intraoperative transit-time flows were obtained. The DF of the ITA graft at the end of operation was evaluated in two groups. RESULTS: The intraoperative DF was significantly greater in the semiskeletonized grafts than in the pedicled grafts (70.50 ± 14.15 versus 57.6 ± 19.39%; p = 0.005). No statistical difference was observed comparing quantitative pulsatile flow and pulsatile index at the end of the operation in the two groups. However, the free flow of the conduit during the cardiopulmonary bypass before the anastomosis performed was greater in semiskeletonized group than in pedicled group (94 ± 48.37 versus 56.35 ± 34.90 ml/min; p = 0.003). The total operative time was comparable between two groups (p = 0.092). CONCLUSIONS: Semiskeletonized ITA resulted in superior DF of left anterior descending bypass graft flow as compared with pedicled ITA. It is also provide a greater free flow and length of the graft without the long-delayed operative time. TRIAL REGISTRATION: Trial registration number (Study ID): TCTR20160913002 Date of registration: September 10, 2016