Effect of internal mammary artery dissection on sternal vascularization

Abstract

Internal mammary artery (IMA) dissection may cause sternal devascularization and ischemia resulting in sternal wound complication. To evaluate the effect of median sternotomy and IMA dissection on sternal vascular supply, sternal bone tomography was performed 7 days and 1 month after cardiac operation in 67 patients. Seventeen nondiabetic patients had single IMA grafts, 18 had double IMA grafts, and 12 had only saphenous vein grafts or valve replacement. Twenty diabetic patients were studied after any one of these operations. Seven patients were restudied 1 month after the operation. Sternal technetium-99m-methylene diphosphate tomography was performed. The sternum was visualized and focal zones of hypoactivity represented sternal hypoperfusion. The ratio of hypoactivity area over total sternal area was calculated for every patient. After median sternotomy without single or double IMA grafts, the averaged hypoperfusion ratio was 4% ± 1% compared with 13% ± 3% after single IMA grafts and 24% ± 6% after double IMA grafts (p < 0.0001). Diabetic patients without IMA, with single IMA, and with double IMAs showed hypoperfusion areas of 5% ± 3%, 15% ± 5%, and 23% ± 9%, respectively, a result similar to that of nondiabetic patients. One month after operation the hypoperfusion area decreased to 2% ± 2% (p < 0.05) in restudied patients. Our results indicate that IMA dissection causes a significant although partial and temporary sternal ischemia, which is more severe after double IMA than single IMA mobilization and which may be incriminated in the development of sternal wound infection. This vascularization defect was not greater among patients with diabetes mellitus.