Comparison of Outcome of Patients undergoing Coronary Artery Bypass Graft Surgery using Pedicled versus Skeletonized Internal Mammary Artery Graft

Abstract

Introduction
Coronary Artery Bypass Grafting (CABG) is a standard procedure to revascularize the ischemic myocardium.Left Internal Mammary Artery (LIMA)is preferred graft due to its superior long term patency.  LIMA can be harvested through either pedicled and skeletonized technique. Skeletonized LIMA is becoming popular due to favourable clinical advantage. This study aimed to compare the clinical outcomes between two harvesting technique.

Methods
This is a prospective comparative observational study of 41 patients who underwent CABG procedure at  cardiac Centre from January 2020 to December 2020. Observational comparative study of 41 patients with 20 patients in Group A(skeletonized LIMA) and 21 patients in Group B (pedicled LIMA ).The clinical parameters like  postoperative drain output and patency of LIMA with selective Angiogram of LIMA at 3 to 6 months were compared.

Results
The mean age of patients in group A was 54.35±6.8 years and in group B it was 57.80±10.88 years. Postoperative drain output was significantly lower in the skeletonized group (426±159.4 mL) compared to the pedicled group (682.85±312.15 mL; p=0.002).The patency of LIMA was 100 percent in Group B  and 83%  in Group A (p =0.40).Among the three atretic LIMA , two were associated with competitive flow due to recanalized LAD and one patient had proximal LIMA stenosis ,unrelated to harvesting method. There were 3 mortalities, not attributable to the harvesting technique.

Conclusion
Both skeletonized or pedicled LIMA technique has similar patency at 3 to 6 months following CABG however skeletonized technique is associated with significant lesser postoperative bleeding.