Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598701
Oral Presentations
Sunday, February 12, 2017
DGTHG: Coronary Heart Disease: Operative techniques
Georg Thieme Verlag KG Stuttgart · New York

Significant Impairment of Parasternal Skin Perfusion after Pediculized Compared to Skeletonized LIMA-Harvesting Measured by Transcutaneous Duplex Sonographic Flow Mapping

D. Inderbitzin
1   Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich, Zürich, Switzerland
,
J. Shahinian
2   Klinik für Herzchirurgie, Universitätsspital Basel, Basel, Switzerland
,
D. Kalbermatten
3   Klinik für Plastische- und Wiederherstellungschirurgie, Universitätsspital Basel, Basel, Switzerland
,
M. Taramasso
1   Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich, Zürich, Switzerland
,
F. Maisano
1   Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich, Zürich, Switzerland
,
F.S. Eckstein
2   Klinik für Herzchirurgie, Universitätsspital Basel, Basel, Switzerland
,
O. Reuthebuch
2   Klinik für Herzchirurgie, Universitätsspital Basel, Basel, Switzerland
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Publikationsdatum:
03. Februar 2017 (online)

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Objective: Impaired parasternal skin perfusion (PSSP) after left intern mammary artery (LIMA) harvesting in coronary arterial bypass surgery (CABG) reflects sternal hypo-perfusion with potential risk of surgical site infection (SSI). We present the impact of pediculized versus skeletonized LIMA-harvesting on PSSP by quantitative transcutaneous duplex sonographic flow mapping. (TDSFM).

Methods: Bilateral TDSFM was performed before and after (postoperative day 5–7) CABG with LIMA-harvesting on 3 parasternal levels (manubrium (M), corpus (C), xyphoid (X)) at 2 cm from midline. Left-sided PSSP was evaluated as % of a right-sided PSSP reference (baseline-value). Data were prospectively collected and analyzed post-hoc.

Results: 5 patients received pediculized and 5 skeletonized LIMA-harvesting. Referring to the right-sided baseline, mean (± SD) pre- / postoperative left-sided PSSP was 92.6 ± 15.4/66.8 ± 6.4% (M), 95.6 ± 5.2/71.2 ± 5% (C) and 107 ± 13.8/76.4 ± 13.6% (X) after pediculized and 100 ± 3.4/100 ± 4.2% (M), 106 ± 14/99 ± 5.1% (C) and 106 ± 15.6/99.8 ± 5.2% (X) after skeletonized LIMA-harvesting. There was a significant difference between left-sided pre- and postoperative measures of 25.8%, 24.4% and 30.6% after pediculized LIMA-harvest on level M, C and X, respectively (p = 0.043 (M), p = 0.043 (C), p = 0.043 (X), by Wilcoxon matched-pairs signed-ranks test). Significant difference was absent after skeletonized LIMA-harvesting: 0%, 7% and 6.2% (p > 0.05 for all levels M, C and X, by Wilcoxon matched-pairs signed-ranks test). Mean pre- to postoperative PSSP decrease was 4.4% and 26.9% after skeletonized and pediculized LIMA-harvesting, respectively.

Conclusion: A significant 26.9% impairment on average in postoperative parasternal skin perfusion after pediculized compared with 4.4% after skeletonized LIMA-harvest suggests to routinely consider skeletonized LIMA-harvesting especially in patients with increased risk for SSI. Further prospective randomized studies are needed to confirm this trend.