Invited commentary

Abstract

Guizilini and colleagues [1Guizilini S. Gomes W.J. Faresin S.M. et al.Influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting.Ann Thorac Surg. 2007; 84: 817-822Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar] add to the body of literature debating the effects of opening the pleura during left internal thoracic artery (LITA) harvest. The authors demonstrate that LITA harvest in general is associated with impaired ventilatory mechanics and reduced oxygenation in the early postoperative period, but these adverse effects are exacerbated by opening the pleura during LITA harvest and placing a tube through the chest wall for drainage. Although the article states that patients were allocated in a randomized, prospective fashion to either intact pleura (IP) or open pleura (OP) LITA harvest groups, it appears that assignment to OP was actually determined by incidental opening of the pleura during an otherwise intended IP harvest. Thus, most OP patients likely had minimal violation of the pleural envelope, suggesting that the major difference in technique between groups (and the basis for the observed differences in outcomes) was actually placement of the chest tube. This apparent impact of placing a chest tube make sense when one considers how much better patients feel after their chest tubes are removed. The difference in mean hospital stay between groups was also likely a factor of the chest tube, and probably not because of its effect on lung function, but because of occasional prolonged drainage. Guizilini and colleagues [1Guizilini S. Gomes W.J. Faresin S.M. et al.Influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting.Ann Thorac Surg. 2007; 84: 817-822Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar] provide food for thought as we all continually fine-tune our operative techniques to maximize patient outcomes, including lengths of stay. If one prefers to open the pleura for LITA harvest, perhaps a softer drainage tube or an alternate route for tube exit (eg, subcostal, rather than through the chest wall) would be appropriate tactics to reduce the adverse effects of the drainage tube on pulmonary function. As we move toward less invasive (ie, nonsternotomy) approaches for CABG, we must be mindful of the effects of placing chest tubes, particularly because these newer approaches often entail bilateral chest drainage. Influence of Pleurotomy on Pulmonary Function After Off-Pump Coronary Artery Bypass GraftingThe Annals of Thoracic SurgeryVol. 84Issue 3PreviewThis study evaluated the influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA). Full-Text PDF