ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Harvesting of Internal Mammarian Artery: The Endothoracic Fasciotomy Procedure
Ahmet KORUKÇU, Hakan GERÇEKOĞLU, Hasan KARABULUT, Onur SOKULLU, Mahmut AKYILDIZ, Hüseyin SOYDEMİR, Ece DUMAN, İsmail AĞAR, Hüseyin TOKLU, Özkan KANTARCI, Besim YİĞİTER
Siyami Ersek Göğüs Kalp Damar Cerrahisi Merkezi, Kardiyovasküler Cerrahi Bölümü
In this study, the effects of endothoracic fasciotomy procedure on the left internal mammary artery (LIMA) blood flow, the LIMA diameter and legnth is compared between two different patient groups. 20 patients who will undergo aortocoronary bypass operation are included in the study. In both groups, systolic, diastolic, and mean arterial blood pressures, the pulmonary capillary wedge pressure (PCWP) and heart rate values are kept constant during the measurements. The mean body surface area of the patients was 1.78±0.15 m2 in the first group and 1.75±0.11 m2 in the second group. At the first measurements done in group 1 and group 2 just after the IMAs are prepared, the mean blood flow rates are found as 39.2±5.0 ml/min. and 39.8±8.9 ml/min. and the mean vessel diameters as 1.15±0.24 mm and 1.20±0.25 mm respectively.

The IMAs in the first group are kept wrapped in a gauze with Papaverin solution for 20 minutes just after the distal end is clipped. This procedure is done in the second group after the endothoracic fasciotomy is completed. When the second measurements are done in group 1 and group 2, the mean blood flows are found es 101±11 ml/min and 114±11 ml/min and the mean vessel diameters as 1.8±0.25 mm and 2.1±0.31 mm respectively. While there was no increase in the graft’s length in the first group, in the second group it increased up to 9%. In this study, the greft lengths, diameters, and the blood flow increased by 9%, 16% (p<0.03), and 12% (p<0.01) respectively in the grafts with fasciotomy.

In this situation; 1) widened vessel diameter increases the IMA blood flow, 2) this increased flow makes a positive effect on the left ventricle performance especially in the early postoperative period, 3) the increase in length enables the graft to be used more proximally avoiding the high risk of spasm on the distal end. We believe that this method innihilates a lot of disadvantages limiting the use of IMA and its usage will increase.

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