Impact of Intact Pleura during Left Internal Mammary Artery Harvesting on Clinical Outcome

Abstract

Background: Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery (LIMA) harvesting.
Methods: Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 54, 46 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events.
Results: The incidence of postoperative pericardial effusion was similar between the groups, but the incidence of postoperative pulmonary complications such as pleural effusion (except for mild pleural effusion) on the second (no: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no:42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value < 0.001 and  pvalue = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild:22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%,mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no:39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value < 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value =0.002) were significantly higher in group A than those in group B.
Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.