Bilateral Internal Mammary Artery Grafting for CABG скачать в хорошем качестве

Bilateral Internal Mammary Artery Grafting for CABG

#CABG #BIMA_Grafting Related video: Skeletonized internal mammary graft vs pedicled graft    • Skeletonized Internal Mammary Graft vs Ped...   Discussion on bilateral internal mammary artery grafting for CABG. Advantage of bilateral internal mammary artery grafting for CABG over using a single arterial conduit is a better survival documented by a meta-analysis of 9 observational studies involving over fifteen thousand patients with follow up over 9 years. But there is a reluctance among some cardiac surgeons to use both internal mammary arteries for fear of deep sternal wound infections, often causing mediastinitis. Important risk factors for deep sternal wound infections are: Obesity Diabetes mellitus Female gender Renal failure Chronic obstructive pulmonary disease Use of skeletonized internal mammary artery grafts instead of pedicled grafts can reduce the risk of sternal wound infection as the sternal vasculature is maintained while harvesting skeletonized grafts. Traditional internal mammary artery harvesting technique involves the dissection of a rim of tissue about one to two centimeters around the artery. Skeletonization procedure was first described by Keeley in 1987. It involves the harvest of only the internal mammary artery without any surrounding tissue. This requires a more careful dissection and has a potential risk of arterial injury. But studies have not shown any difference in microscopic injury or vascular function between the conventional versus skeletonized harvesting of the internal mammary artery. Increased length and flow, decreased sternal infections and reduced pain are the proposed benefits of skeletonized internal mammary artery harvesting and grafting as compared to conventional method. It has been shown that there is significant reduction of postoperative pain and dysesthesia with skeletonized grafts and increased sternal perfusion has been demonstrated, which can reduce the rate of deep sternal wound infection.