Skeletonized Left Internal Mammary Artery Harvesting is better than Pedicled Left Internal Mammary Artery Harvesting in the Context of Sternal Wound Complication Following Off-Pump Coronary Artery Bypass Grafting
Authors: Hossain Aslam , Nishat Farhat Tabassum , Shanta Tania Nusrat , Maruf Abul Bashar , Shawkat Sumaia Binte 
Published: December 2024

Background: Off-pump coronary artery bypass grafting’s most difficult complication is sternal wound. Left internal mammary artery harvesting affects sternal wound complications. It is unclear which left internal mammary artery harvesting method prevents sternal wound complications. Skeletonized and pedicled left internal mammary artery harvesting were compared for sternal wound complications during off-pump coronary artery bypass grafting. As a result, proper methodology might be supported as an attractive method to decrease the incidence of sternal wound complication. Material & Methods: This comparative cross-sectional study was conducted at the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University. Total 120 patients were enrolled after fulfilling the selection criteria and divided into two groups. Among them,60 patients of group A received skeletonized left internal mammary artery whereas 60 patients of group B received pedicled left internal mammary artery. After performing off-pump coronary artery bypass grafting postoperative ICU care was given to each patient as per ICU protocol. Statistical analysis was conducted using Statistical Package for Social Science (SPSS) version 26.0 for windows software. Comparisons between groups were made with Student’s t-test, Chi-Square test and Fisher’s exact test. Observations were recorded as statistically significant if ap-value ≤0.05. Results: In this study 10 (8.33%) patients developed sternal wound complication. Among them2 (1.67%) patients in group A and 8 (6.66%) patients in group B developed sternal wound complication. Occurrence of sternal wound complication was more in group B than group A which was not statistically significant(p=0.35). The mean age of patients in Group A and Group B were 54.34±10.55 years and 53.50±11.70 years respectively. Age was not statistically significant between two groups (p=0.89). The gender difference among two groups were not also statistically significant(p=0.69). Mean BMI was 24.33±1.65 in group A and 24.55±1.45 in group B and findings were not statistically significant between groups (p=0.76). The differences between comorbidities (HTN, DM, dyslipidaemia, anaemia) of both groups were statistically insignificant (p>0.05). However, number of smokers was statistically significant between groups (p=0.03). Sternal wound complication was

more in smoker patients in group B and this finding was statistically significant(p=0.04). Mean ± SD number of bypass grafts used by group A was 2.76±0.79 and group B was 2.83 ±0.65(P=0.69). Pre-operative parameters such as duration of operation and post-operative parameter like duration of mechanical ventilation, duration of chest drains, duration of central venous line and amount of postoperative mediastinal bleeding were found statistically not significant between groups (p>0.05). Comparison of postoperative laboratory parameters was statistically not significant between groups. Distribution of wound complications, duration of ICU and hospital stay between two groups were also not statistically significant (p>0.05). Conclusions: Occurrence of sternal wound complication was found less in skeletonized left internal mammary artery harvesting than pedicled left internal mammary artery harvesting after off-pump coronary bypass grafting in this study. But this finding was not statistically significant.