174 Semi-Skeletonized Versus Pedicled Internal Mammary Artery Harvesting: A Systematic Review

Abstract

Abstract Objectives To compare semi-skeletonized with pedicled harvesting technique of the internal mammary artery for coronary artery bypass surgery. Method A comprehensive literature search was performed on PubMed, Cochrane database, Embase, Google Scholar and Ovid identifying articles that compared semi-skeletonised to pedicled internal mammary artery in the use of coronary artery bypass surgery. Databases were evaluated and assessed from inception to July 2020. Results Only five studies fulfilled the criteria for this review. There was no reported incidence of sternal wound infection, myocardial infarction, or mortality. The length of the IMA graft was longer in the semi-skeletonized group compared to the pedicled group, 16.06cm versus 14.63cm respectively (p < 0.001). The intraoperative diastolic flow was significantly greater in the semi-skeletonized grafts than in the pedicled grafts during (p = 0.003) and after (p = 0.005) cardiopulmonary bypass. The incidence of pleural effusion (pedicled, 52.6%; semi-skeletonized, 23.6%; p = 0.002) and atelectasis (pedicled, 42.1%; semi-skeletonized, 20.0%, p = 0.015) were significantly higher in pedicled group. Post-operative chest tube drainage was significantly higher in the pedicled group (608 ± 58 mL compared to 470 ± 48 mL; p = 0.027). Additionally, FEV1 was significantly decreased in the pedicled group 6 days after surgery (pedicled:76.0% ± 1.6%; semi-skeletonized: 83.2% ± 1.6%; p = 0.020). Conclusions These results demonstrate that the semi-skeletonized preparation technique is associated with satisfactory outcomes during harvesting the internal mammary artery. Yet, due to limited numbers of studies, there is need for larger comparative studies to assess post-operative outcomes with a longer period of follow up.