Internal Mammary Artery Harvesting Research Articles

Harmonic Scalpel for Internal Mammary Artery Harvest

Internal mammary artery (IMA) harvest by using a harmonic scalpel for coronary artery bypass grafting (CABG) have not been sufficiently evaluated. This review aimed to assess the outcomes of IMA harvest by a harmonic scalpel and to compare by conventional electrocautery. The study materials were based on literature retrieval. In total Eight articles describing IMA harvest by a harmonic scalpel for 1,893 patients, and pateints with IMA harvest by electrocautery were taken as controls. IMA harvest by a harmonic scalpel was associated with less thermal injury with potentially better preservation of the endothelial cells, satisfactory intraoperative IMA flow, and promising postoperative IMA patency. Apart from the harvesting merits, the harmonic scalpel had many other advantages in terms of clinical outcomes, such as decreased postoperative mortality and morbidity rates. Nevertheless, IMA harvesting by using a harmonic scalpel is associated with longer harvest time, prolonged operative time, and increased hospitalisation expenses. Therefore, they could be used in selected and non-emergent patients for CABG. Key Words: Coronary artery bypass grafting, Internal mammary artery, Surgical instruments.

Impacts of Skeletonized Bilateral Internal Mammary Artery Bypass Grafting on the Risk of Deep Sternal Wound Infection.

This single-center study aimed to evaluate the incidence of deep sternal wound infection (DSWI) following skeletonized bilateral internal mammary artery (BIMA) harvest in a Chinese cohort. Using propensity score matching, this study also provided a present-day assessment of the impacts of skeletonized BIMA grafting versus skeletonized single internal mammary artery (SIMA) grafting on early outcomes.From January 2014 to December 2017, 2403 eligible patients were entered into either a BIMA group (n = 368) or a SIMA group (n = 2035). The incidence of DSWI was recorded. Analysis of early outcomes was further performed for propensity score-matched (1:1) cohorts.The BIMA group received a similar incidence of DSWI as did the SIMA group (1.6% versus 0.9%, P = 0.247). No significant differences between subgroup diabetic-BIMA, subgroup nondiabetic-BIMA, subgroup diabetic-SIMA, and subgroup nondiabetic-SIMA were found regarding the incidence of DSWI (2.0%, 1.4%, 1.0%, and 0.7%, respectively; P > 0.05 between groups). After matching, treatment type (skeletonized BIMA grafting versus skeletonized SIMA grafting) was not an independent risk factor for postoperative DSWI (OR = 1.309, 95% CI 0.897-2.714, P = 0.704) or predictors of other early outcomes. Additionally, the two matched groups shared similar early outcomes (including postoperative DSWI), regardless of whether or not the merger with diabetes (all P > 0.05).Skeletonized BIMA harvest as compared with skeletonized SIMA harvest was not associated with an increased risk of DSWI, regardless of whether or not the merger with diabetes. Patients with skeletonized BIMA grafting received similar surgical mortality and major postoperative morbidity as did matched patients with skeletonized SIMA grafting.

Internal mammary harvesting: Techniques and evidence from the literature.

Coronary artery bypass graft (CABG) is one of the most commonly performed cardiac surgeries in the world. CABG using the internal mammary artery (IMA) remains the gold standard intervention for myocardial intervention in multivessel coronary artery disease. IMA harvesting can be performed with various techniques and approaches: pedicled vs skeletonized harvesting technique as well as approaches such as conventional sternotomy, robotic and endoscopic approaches. While each technique and approach have their respective advantages and disadvantages, evidence remains varied between cohorts. Traditionally, IMA has been used as an in situ conduit; however, IMA free grafts also provide satisfactory outcomes in certain situations. This literature review aims to explore the efficacy of different techniques and approaches of IMA harvesting and grafting. With evidence compiled, this will provide an overview of the complexity of CABG and locate gaps in current literature to direct future research.

Open Versus Closed Pleura Internal Mammary Artery Harvesting and Early Pulmonary Function After Coronary Artery Bypass Grafting

The internal mammary artery is the vessel of choice for myocardial revascularisation during coronary artery bypass grafting (CABG). Although it is possible to harvest the left internal mammary artery (LIMA) without opening the left pleura, pleurotomy is usually performed to provide adequate exposure and allow the placement of the LIMA medial to the upper lobe, preventing any undue tension on the mammary pedicle. However, the intact pleura technique may have a lower risk of postoperative pulmonary complications. We aimed to study the effects of both procedures on pulmonary function and the incidence of complications. One hundred patients with ischaemic heart disease indicated for CABG were included and divided into two groups. The closed pleural technique group included 50 patients with preservation of the pleural integrity during mammary harvesting. The open pleural procedure group included 50 patients without preservation of pleural integrity. Spirometry was done pre- and postoperatively in both groups and postoperative pulmonary complications in both groups were recorded and analysed. Internal mammary harvesting with preservation of pleural integrity during CABG in patients in the closed pleural procedure group showed significant improvement in forced expiratory volume in the first second (FEV1%), forced vital capacity (FVC%), and FEV1/FVC compared with the corresponding values in patients in the open pleural procedure group, on day 5 postoperatively, at discharge, and at day 30. There were fewer complications in preservation of pleural integrity with regard to lung atelectasis and pleural effusion, which were significantly lower in patients in the open pleural procedure group. Preservation of pleural integrity has beneficial effects on pulmonary function and has fewer associated pulmonary complications.

Assessment of compromised parasternal skin perfusion after left internal mammary artery harvesting with a novel laser Doppler imaging.

Our aim was to investigate the impact of the non-skeletonized (pedicled) versus the skeletonized left internal mammary (LIMA) harvesting technique on the postoperative sternal and parasternal skin perfusion in patients undergoing coronary artery bypass grafting (CABG), as compared to patients undergoing non-CABG heart surgery. We included 142 patients who underwent non-bypass (N.=39) or CABG surgery (N.=103). CABG cases were differentiated according to the LIMA harvesting technique: skeletonized (N.=74) or non-skeletonized (N.=29). Parasternal and sternal skin perfusion measurements via a Laser Doppler Imaging tool were performed on the preoperative day and 5-7 days postoperatively, using a grid of 15 spatially segregated measurement points across the chest and normalization to a distinct reference point. Data were analyzed retrospectively. In the CABG group, the non-skeletonized LIMA harvesting resulted in a near-significant (P=0.057, two-sided Student t-test, 95% CI -[0.111, 0.002]), and the skeletonized LIMA harvesting in a significant (P< 0.001, 95% CI [-0.096, -0.032]) post-surgical decrease of left-sided parasternal skin perfusion in arbitrary perfusion units (APU), as compared to right-sided parasternal skin perfusion. No corresponding differences were found for the non-bypass group (P=0.5, 95% CI [-0.065, 0.033]). The harvesting techniques did not yield significantly different post-surgical parasternal skin perfusion measures in the CABG group (P=0.6). Measurement of parasternal skin perfusion using Laser Doppler Imaging is feasible. Both harvesting techniques resulted in a reduced parasternal/sternal skin perfusion upon removal of the internal mammary artery.

Sternal wound closure in the current era: the need of a tailored approach.

Median sternotomy remains the most common access to perform cardiac surgery procedures. However, the experience of the operating surgeon remains a crucial factor during sternal closure to avoid potential complications related to poor sternal healing, such as mediastinitis. Considering the lack of major randomized controlled trials and the heterogeneity of the current literature, this narrative review aims to summarize the different techniques and approaches to sternal closure with the aim to investigate their reflections into clinical outcomes and to inform the choice on the most effective closure method after median sternotomy. A literature search through PubMed, Embase, EBSCO, Cochrane database of systematic reviews, and Web of Science from its inception up to April 2019 using the following search keywords in various combinations: sternal, sternotomy, mediastinitis, deep sternal wound infection, cardiac surgery, closure. Single wire fixation methods, at present, seems the most useful method to perform sternal closure in routine patients, although patients with a fragile sternum might benefit more from a figure-of-eight technique. In high-risk patients (e.g. chronic pulmonary disease, obesity, bilateral internal mammary artery harvesting, diabetes, off-midline sternotomy), rigid plate fixation is currently the most effective method, if available; alternatively, weave techniques could be used. The choice among the sternal closure techniques should be mainly inspired and tailored on the patient's characteristics, and correct judgement and experience play a pivotal role. A decisional algorithm has been proposed as an attempt to overcome the absence of specific guidelines and to guide the operative approach. This operative approach might be used also in non-cardiac procedure in which median sternotomy is required, such as in case of thoracic surgery.

Internal mammary artery harvesting with its distal end occluded.

Internal mammary artery harvesting with its distal end occluded.

IP095. Simultaneous Transcarotid Revascularization With Flow Reversal and Coronary Artery Bypass Grafting

The optimal surgical management for patients with concomitant carotid and coronary disease remains unknown. We sought to investigate the safety of simultaneous transcarotid artery revascularization (TCAR) with the ENROUTE transcarotid neuroprotection and stent system (Silk Road Medical Inc, Sunnyvale, Calif) and coronary artery bypass grafting (CABG). We retrospectively reviewed our experience with synchronous TCAR-CABG performed between February 2018 and January 2019. All patients first underwent a median sternotomy and harvesting of the left internal mammary artery before dissection of the common carotid artery (CCA) and placement of a venous sheath in the right femoral vein. The patients were then heparinized and the proximal CCA cannulated. Arteriography was first performed to demonstrate the extent and exact location of the stenosis before exchanging the arterial sheath and connecting to the flow reversal system. Active flow reversal was achieved by clamping the CCA. Access to the carotid artery was obtained in the mediastinum. The lesions were then crossed, predilated and stented. All sheaths were removed and arteriotomies closed before three-vessel CABG was performed by the cardiac surgery team. Plavix load was administered at the completion of the CABG. Primary end points included perioperative stroke and death. Secondary end points were technical success and postoperative hemorrhage. Three male patients (mean age, 63 years) underwent simultaneous TCAR-CABG. All 3 patients had symptomatic coronary artery disease. Regarding carotid artery disease, one patient had symptomatic disease; the other two patients were asymptomatic, but had critical (>75%) internal carotid stenosis. The procedural success rate was 100%. The average flow reversal time during TCAR was 11 minutes. There were no perioperative strokes or deaths. There were no re-explorations for hemorrhage (Table). Concomitant coronary and carotid artery disease is a challenging clinical scenario. Outcomes from this small patient cohort reveal that simultaneous TCAR-CABG is technically feasible and safe. This novel approach has the potential to provide the morbidity benefits of an EVR strategy while mitigating the risk of stroke by avoiding manipulation of the aortic arch. However, further investigation with larger patient groups is required before widespread adoption of this innovative technique.TableOutcomesAdverse outcomes Ipsilateral stroke (n = 3)0 (0%) Death (n = 3)0 (0%) Re-exploration hemorrhage (n = 3)0 (0%)Procedural parameters Flow reversal time, minutes (n = 3)11.3 (±1.9) Technical success (n = 3)3 (100%) Open table in a new tab

On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

Objective:To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery.Methods:The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19.Results:In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424.Conclusions:The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit.

Pulmonary complications following cardiac surgery.

Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient’s assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.

MICS-CABG with left internal mammary artery harvesting using da Vinci Surgical System

MICS-CABG with left internal mammary artery harvesting using da Vinci Surgical System

Beneficios inmediatos de la utilización de un separador pulmonar flexible durante la disección esqueletizada de la arteria mamaria interna

ObjectiveTo determine the trans-operative benefits of a malleable lung retractor placement during skeletonised internal mammary artery harvesting in coronary artery bypass graft surgery. MethodsA descriptive cross-sectional study was conducted by analysing the trans-operative variables of 62 patients who required a lung retractor placement during left internal mammary artery harvesting. ResultsThe separator was used in 57 patients. The duration of mammary dissection was significantly longer when the retractor was not used (55.5±4.5 vs. 50.4±4.67min). There was also more bleeding during the procedure in that group (69±20.74 vs. 57.2±12.17ml). Pleural cavity integrity was preserved in 87.7% of the patients in whom the retractor was used. ConclusionsClear benefits of the use of lung retractor were demonstrated in terms of decreased mammary artery dissection time, and preservation of pleural cavity, as well as mammary vein integrity.

Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting: A Proof-of-Concept Study in 20 Patients.

At present, minimal invasive direct coronary artery grafting is the least invasive nonrobotic surgical approach to revascularize the left anterior descending artery with the left internal mammary artery. Total endoscopic coronary bypass grafting is performed with the help of a telemanipulator ("robot"). A prospective proof-of-concept study was initiated to investigate a nonrobotic total endoscopic coronary bypass grafting approach. Twenty patients with significant left anterior descending artery or left main stem lesion were operated on via three or four left thoracic access ports. Under exclusive endoscopic vision, the left internal mammary artery was harvested and anastomosed to the left anterior descending artery manually. Cardiopulmonary bypass and cardioplegic arrest were planned in all cases. In 10 patients, the operation was completed successfully as nonrobotic total endoscopic coronary bypass grafting. Reasons for conversions to minimal invasive direct coronary artery grafting or conventional sternotomy were dense pleural adhesions (3 patients), bleeding of the anastomosis (3), diffuse bleeding during left internal mammary artery harvesting (2), identification problems of the target artery (1), or left internal mammary artery failure (1). Postoperative angiography in five primarily successful nonrobotic total endoscopic coronary bypass grafting patients showed patent anastomoses in four cases. One patient was reoperated on for early anastomotic failure in a 1.0-mm target vessel. Until now, a percutaneous coronary intervention of remaining lesions as staged hybrid procedure was performed in three patients (2 nonrobotic total endoscopic coronary bypass grafting, 1 minimal invasive direct coronary artery grafting). With a thoroughly surveyed learning curve, nonrobotic total endoscopic coronary bypass grafting procedure could become an alternative to other available treatment options; however, the value of the procedure has to be further investigated.

Factors causing prolonged mechanical ventilation and peri-operative morbidity after robot-assisted coronary artery bypass graft surgery.

Robot-assisted coronary artery bypass graft [robot-assisted (coronary artery bypass grafting (CABG)] surgery is the latest treatment for coronary artery disease. However, the surgery extensively affects cardiac and pulmonary function, and the risk factors associated with peri-operative morbidity, including prolong mechanical ventilation (PMV), have not been fully examined. In this retrospective cohort study, a total of 382 patients who underwent robot-assisted internal mammary artery harvesting with mini-thoracotomy direct-vision bypass grafting surgery (MIDCABG) from 2005 to 2012 at our tertiary care hospital were included. The definition of PMV was failure to wean from mechanical ventilation more than 48h after the surgery. Risk factors for PMV, and peri-operative morbidity and mortality were analyzed with a multivariate logistic regression model. Forty-three patients (11.3%) developed PMV after the surgery, and the peri-operative morbidity and mortality rates were 38 and 2.6%, respectively. The risk factors for PMV were age, left ventricular ejection fraction (LVEF), the duration of one-lung ventilation for MIDCABG (beating time), and peak airway pressure at the end of the surgery. Furthermore, age and anesthesia time were found to be independent risk factors for peri-operative morbidity, whereas age, LVEF, and anesthesia time were the risk factors for peri-operative mortality. These findings may help physicians to properly choose patients for this procedure, and provide more attention to patients with higher risk after surgery to achieve better clinical outcomes.

Cost and Outcome of Minimally Invasive Techniques for Coronary Surgery Using Robotic Technology.

Totally endoscopic coronary artery bypass (TECAB) with robotic distal anastomosis and robotic-assisted minimally invasive coronary artery bypass (RA-MIDCAB) with robotic internal mammary artery harvest and direct hand-sewn distal anastomosis via an anterior thoracotomy have both been reported as safe and efficacious. We compared hospital cost and short-term outcomes between these techniques. Patients who underwent robotic-assisted minimally invasive single-vessel Coronary artery bypass grafting (2011-2014) were retrospectively reviewed. One hundred consecutive patients underwent either TECAB (n = 50) or RA-MIDCAB (n = 50). The two groups were sequential with TECAB performed by one surgeon in the first portion of the study interval and RA-MIDCAB by another surgeon in the latter. Demographics, short-term outcomes, and hospital cost data were compared between the two groups. Patient demographics and preoperative risk factors were similar between the TECAB and RA-MIDCAB groups, as total operating room time. Cardiopulmonary bypass was used for 56% of TECAB and 0% of RA-MIDCAB cases (P < 0.001). Intensive care unit and hospital lengths of stay, along with postoperative morbidities, were similar between the two groups. Operative mortality was 2% in the TECAB and 0% in the RA-MIDCAB group (P = NS). Total hospital cost was significantly higher with TECAB compared with RA-MIDCAB (US $33,769 vs. $22,679, P < 0.001), which was primarily driven by operative costs (US $17,616 vs. $26,803, P < 0.001). Totally endoscopic coronary artery bypass and RA-MIDCAB both demonstrated excellent short-term clinical outcomes. However, TECAB was associated with significantly higher hospital costs. Further comparisons, including long-term outcomes, patient satisfaction, and functional status, are needed to evaluate whether this additional cost is justified.

Techniques for internal mammary artery harvesting exposure

Techniques for internal mammary artery harvesting exposure

Endoscopic harvesting of internal mammary artery for coronary artery bypass grafting

Endoscopic harvesting of internal mammary artery for minimally invasive coronary artery bypass surgery seems to be highly justified and expedient. Technical features of this procedure are reviewed in the article. There are certain advantages of this method including ligation of proximal branches, reduced surgical trauma, better cosmetic results and enhanced postoperative rehabilitation.

Meta-analysis of the Sources of Bleeding after Adult Cardiac Surgery

The aim of this study was to pool data on the proportion and prognostic impact of sources of bleeding in patients requiring re-exploration after adult cardiac surgery. Systematic review of the literature and meta-analysis. Multistitutional study. A literature review was performed to identify studies published since 1990 evaluating the outcome after reoperation for bleeding or tamponade after adult cardiac surgery. Eighteen studies including 5,1497 patients fulfilled the selection criteria. Reoperation for bleeding/tamponade was performed in 2,455 patients (4.6%; 95% confidence interval [CI] 3.9%-5.2%, I2 92%). These had a significantly higher risk of in-hospital/30-day mortality compared with patients not reoperated for bleeding (pooled rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52-4.32; I2 47%; 8 studies; 25,463 patients). Surgical sites of bleeding were identified in 65.7% of cases (95% CI 58.3%-73.2%; I2 94%), cardiac site bleeding in 40.9% of cases (95% CI 29.7%-52.0%; I2 94%), and mediastinal/sternum site bleeding in 27.0% of cases (95% CI 16.8%-37.3%; I2 94%). The main sites of bleeding were the body of the graft (20.2%), the sternum (17.0%), vascular sutures (12.5%), the internal mammary artery harvest site (13.0%), and anastomoses (9.9%). In metaregression, surgical site bleeding was associated with a lower risk of in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003). Surgical site bleeding is identified in two-thirds of patients undergoing re-exploration after adult cardiac surgery. Meticulous surgical technique and systematic intraoperative checking of potential surgical sites of bleeding at the time of the original cardiac surgery may reduce the risk of such a severe complication.

Robot-assisted totally endoscopic coronary bypass surgery

Totally endoscopic coronary artery bypass (TECAB) surgery can exclusively be undertaken with the aid of operative robots. In the past two decades, surgical remote manipulator systems—predominantly the daVinci® devices—have brought us the reality of endoscopic internal mammary artery harvesting and coronary bypass anastomoses via minimally invasive thoracic port access. Single up to quadruple TECAB interventions are recently feasible; the procedure can be delivered either as beating heart applying endoscopic vacuum stabilizer or under cardioplegic arrest on heart-lung machine. Significant surgical team learning curves are involved in a stepwise development of these complex procedures, including intense dry- and wet-lab trainings, endoscopic internal mammary artery harvesting and manual coronary anastomosis building through a thoracotomy. Increasing number of papers have been published regarding clinical TECAB series in the past decade. In arrested heart TECAB procedures on cardiopulmonary bypass, the conversion rate from port access to larger thoracic incision measures 15.1% and no perioperative mortality is observed in published records. Stroke, kidney failure and atrial fibrillation rates stay at 0.6, 0.4 and 12.9%, respectively. Analysis of beating heart TECAB procedures revealed a conversion rate of 15.3%, perioperative mortality 0.4%, stroke 0.3%, kidney failure 0.6% and atrial fibrillation 9.2%. Additionally, due to the obviously smaller surgical trauma, a remarkable fast return to normal daily activities can be demonstrated in clinical series of robotic assisted coronary bypass surgery. Short-term freedom of major adverse cardiac and cerebral events (MACCE) stays over 90%. Long-term studies reveal 5-year freedom of MACCE in the 75.2 to 83.1% range. Nowadays, total endoscopic coronary artery bypass grafting is a feasible and reproducible surgical method. Advanced hybrid coronary interventions offer complex multivessel TECAB with support of percutaneous coronary interventions (PCI). Combination of the above techniques widens the spectrum of minimally invasive therapeutic solutions concerning multivessel procedure including bilateral internal mammary grafts and drug-eluting stents.

Changes in sternal perfusion following internal mammary artery bypass surgery.

Coronary bypass surgery using the internal mammary artery (IMA) is among the most commonly performed procedures in treatment of advanced coronary vessel disease. Further, bilateral harvesting of the IMA is associated with increased rates of sternal wound infections. This study aimed to explore changes in sternal perfusion, following left internal mammary artery (LIMA) harvesting. 60 patients were divided equally into intervention- and control cohorts and underwent assessment of oxygen saturation (sO2) and relative blood flow (RBF) by laser doppler flowmetry remission spectroscopy preoperatively, 24 h and 72 h postoperatively. 24 h postoperatively a significant decrease of sO2 and RBF could be detected in LIMA harvest patients. After 72 h this difference disappeared. The side comparison within the groups 24 h postoperatively revealed a reduction of sO2 on the LIMA side within both groups. Regarding the 24 h RBF in side comparison, no significant differences could be detected within the groups. The 72 h side comparison showed an increased RBF for the non-LIMA side within the control group. The use of the LIMA may lead to significant decreases in local tissue oxygen saturation and RBF. This reduction is mostly distinct within the first 3 days postoperatively and may influence sternal wound infections.