Pleura Preservation During Mammary Artery Harvesting for Coronary bypass Grafting: Impact on Short-term Outcome

Background: during coronary artery bypass grafting (CABG) the surgical opening of pleura allows a better exposure for internal thoracic artery (ITA) harvesting. However, pleura preservation seems to improve post-operative clinical outcome. The aim of this retrospective observational study was to compare short-term outcome between preserved versus opened pleura during ITA harvesting.

Methods: from May 2012 to May 2015, 354 patients undergoing isolated coronary artery bypass grafting (CABG) operation (with or without pump) were included in the study. The mammary artery was always harvested in a skeletonized fashion. Patients were divided into two groups: Group A (n=227) with open pleura and Group B (n=127) with intact pleura. Patients’ preoperative, operative and postoperative parameters were compared using the unpaired t test, the Mann Whitney test or the chi-square test for normally, non-normally and categorical data respectively. Factors achieved statistical significance if p<0,05.

Results: there were no significant statistical differences between Group A and Group B for: age, body mass index, ejection fraction, cardiopulmonary bypass time, cross-clamp time, number of anastomoses/patient. Group A and Group B were significantly different in terms of median ventilation time (8 h vs 7 h, 95%CI 7-9 vs 6-8; p=0,0299), length of hospital stay (12 vs 10 days; 95%CI 11-13 vs 9-12; p=0,05), bleeding within 12 hours (420 mL vs 310 mL; 95%CI 380-470 vs 260-380; p<0,0001) and need of blood transfusion (64,1% vs 35,9%; p=0,0307).

Conclusions: our data showed that pleura preservation during ITA harvesting for CABG has significant impact on post-operative course. Pleural integrity reduce postoperative bleeding with a minor need of blood transfusion. Very likely these findings along with a less time of ventilation might reduce the length of hospital stay.