ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Does opening the pleura during internal mammary artery harvesting decrease the risk of tamponade?
Ali Rıza Cenal1, Hayrettin Tekümit1, Cenk Tataroğlu1, Kemal Uzun1, Adil Polat2, Esat Akıncı1
1Department of Cardiovascular Surgery, Avrupa Şafak Hospital, İstanbul
2Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul
Background: In this study we investigated the effect of opening the pleura on the rates of early postoperative bleeding and/or cardiac tamponade.

Methods: The clinical data of 2110 patients who underwent coronary artery bypass grafting (CABG) between January 2007 and September 2009 in our clinic were retrospectively evaluated with regard to opening of pleura and development of tamponade. Sixty-six patients (3.1%) who required reoperation due to early postoperative bleeding and/or tamponade were identified.

Results: Similar rates of emergency revision (2.9% versus 3.2%, respectively; p=0.85) and tamponade (1.8% versus 1.3%, respectively; p=0.46) were observed among patients with opened pleura (n=46) and intact pleura (n=20). Among the subset of patients who required early reoperation for bleeding/tamponade, tamponade was present in 12 patients (60.0%) with intact pleura compared to 18 patients (39.1%) in whom pleura was opened (p=0.178). Development of tamponade was associated with an increased total drainage, increased time to reoperation, prolonged duration of intubation and increased use of inotropic agents.

Conclusion: Opening the pleura during CABG for internal mammary artery harvesting does not decrease the incidence of tamponade. Although larger studies are required, leaving the pleura intact may be the preferred option in most CABG patients.

Keywords : Coronary artery bypass grafting; internal mammary artery harvesting; intact pleura; opening the pleura; tamponade
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