Impact of Preparation Quality during Skeletonized Internal Mammary Artery Harvesting on Sternal Microcirculation

Objectives: Previous studies have demonstrated that skeletonized internal mammary artery (IMA) harvesting reduced the incidence of postoperative sternal infections and morbidity. However, the preparation quality has yet not been investigated.

Methods: Sternal microcirculation (sLDP) with a laser Doppler perfusion (LDP) needle probe was measured during skeletonized left internal mammary artery (IMA) preparation with or without coagulation of the satellite veins (n = 12/groups) in a pig model. In the sham-operated group, the blood flow through the IMA was stopped by clipping the vessel, to show the effect of total avoidance of any surgical manipulation on sLDP.

Results: sLDP is significantly reduced to 56 ± 24% (p < 0,001) after skeletonized IMA harvesting, however, after coagulation of the satellite veins an additional reduction of sLDP to 77 ± 14% (p = 0.024) was demonstrated compared to sLDP with noncoagulated satellite veins. IMA clipping in the sham-operated group reduced sLDP to 70 ± 25% (p = 0.055).

Conclusion: IMA harvesting caused a significant reduction of sternal microcirculation. Avoidance of coagulation of the satellite veins during IMA harvesting should be taken into consideration, to prevent further decline of sLDP.