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Dr. Ahmed Sobhy AbdAllah Mohamed Emara :: Publications:

Title:
Open Versus Closed Pleura Internal Mammary Artery Harvesting and Early Pulmonary Functions After Coronary Artery Bypass Grafting
Authors: Moataz E. Rezk, MDa, Mohammed A. Elgazzar, MDa, Shaimaa M. Abo Youssef, MDb, Ahmed S. Emeraa, MDa, Ahmed E. Elkafoury, MDc, Hany H. Moussa, MDd,*
Year: 2019
Keywords: CABG  Pulmonary function  Internal mammary artery  Pleural integrity
Journal: Heart, Lung and Circulation
Volume: Not Available
Issue: Not Available
Pages: Not Available
Publisher: Not Available
Local/International: International
Paper Link: Not Available
Full paper Ahmed Sobhy AbdAllah Mohamed Emara_2.pdf
Supplementary materials Not Available
Abstract:

Background The internal mammary artery is the vessel of choice for myocardial revascularisation during coronary artery bypass grafting (CABG). Although it is possible to harvest the left internal mammary artery (LIMA) without opening the left pleura, pleurotomy is usually performed to provide adequate exposure and allow the placement of the LIMA medial to the upper lobe, preventing any undue tension on the mammary pedicle. However, the intact pleura technique may have a lower risk of postoperative pulmonary complications. We aimed to study the effects of both procedures on pulmonary function and the incidence of complications. Method One hundred patients with ischaemic heart disease indicated for CABG were included and divided into two groups. The closed pleural technique group included 50 patients with preservation of the pleural integrity during mammary harvesting. The open pleural procedure group included 50 patients without preservation of pleural integrity. Spirometry was done pre- and postoperatively in both groups and postoperative pulmonary complications in both groups were recorded and analysed. Results Internal mammary harvesting with preservation of pleural integrity during CABG in patients in the closed pleural procedure group showed significant improvement in forced expiratory volume in the first second (FEV1%), forced vital capacity (FVC%), and FEV1/FVC compared with the corresponding values in patients in the open pleural procedure group, on day 5 postoperatively, at discharge, and at day 30. There were fewer complications in preservation of pleural integrity with regard to lung atelectasis and pleural effusion, which were significantly lower in patients in the open pleural procedure group. Conclusions Preservation of pleural integrity has beneficial effects on pulmonary functions and has fewer associated pulmonary complications

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