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Effect of internal thoracic artery preparation on blood loss, lung function, and pain

1999; Elsevier BV; Volume: 67; Issue: 4 Linguagem: Inglês

10.1016/s0003-4975(99)00161-7

1552-6259

Gerhard Wimmer‐Greinecker, Mohssen Yosseef-Hakimi, Torsten Rinne, Roland Buhl, G. Matheis, Sven Martens, K. Westphal, Anton Moritz,

Mechanical Circulatory Support Devices

Background. Postoperative blood loss, respiratory distress, and pain after coronary artery operation were assessed in a prospective, randomized, clinical study comparing two techniques of internal thoracic artery preparation.Methods. In group A (n = 57) the internal thoracic artery was dissected with the entire surrounding connective tissue after opening the pleura, using routine lateral pleural drainage. In group B (n = 55) a venoarterial pedicle was prepared without surrounding muscle leaving the pleura intact. We assessed blood loss, clinical outcome, lung function, location, intensity, and quality of pain 6 days and 3 months after the operation.Results. Significantly higher blood loss was observed in group A (A, 608 ± 58 mL; B, 470 ± 48 mL; p = 0.027). Forced expiratory volume in 1 second was significantly decreased in group A 6 days after surgery (A, 76.0% ± 1.6%; B, 83.2% ± 1.6%; p = 0.020). The forced expiratory volume in 1 second correlated to inspiratory vital capacity, which confirmed the advantage of the venoarterial technique (A, 0.771 ± 0.021; B, 0.832 ± 0.020; p = 0.003). Vital capacity was significantly higher in the venoarterial group at 3 months (A, 85.2% ± 2.1%; B, 98.5% ± 1.2%; p = 0.009), but not on postoperative day 6. The incidence of pleural effusion and atelectasis was significantly higher in group A (effusion: A, 52.6%; B, 23.6%; p = 0.002; atelectasis: A, 42.1%; B, 20.0%, p = 0.015). Sternal pain (A, 36.8%; B, 9.1%; p = 0.001) and suspenders pain (A, 33.3%; B, 7.3%; p = 0.001) occurred more often in group A. When using a multidimensional pain score, patients in group A experienced significantly sharper (6 days: A, 6.7 ± 0.3; B, 3.3 ± 0.2; p = 0.018; 3 months: A, 3.5 ± 0.3; B, 1.4 ± 0.3; p = 0.046) and more annoying pain (6 days: A, 7.6 ± 0.2; B, 2.7 ± 0.1; p = 0.036; 3 months: A, 6.6 ± 0.3; B, 2.3 ± 0.2; p = 0.040).Conclusions. These results demonstrate that the venoarterial preparation technique is superior to conventional internal thoracic artery preparation regarding postoperative blood loss, lung function, and pain.