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Comparison of Endoscopic Versus Conventional Internal Mammary Harvesting Regarding Unligated Side Branches
Mahmood Reza Sarzaeem, Saleh Sandoughdaran.
Cardiac Surgery and Transplantation Research Center,Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.

OBJECTIVE: In an effort to minimize access in cardiac surgery, endoscopic vessel harvesting has become more popular. The endoscopic approach, however, allows for only the harvest of the mid to distal internal mammary artery (IMA), leaving the more proximal branches of the conduit available for collateral flow away from the coronary bed. The aim of this study was to compare the number and anatomic variation of remaining side branches in thoracoscopic versus conventional internal mammary artery (IMA) harvesting.
METHODS: 199 fresh cadavers were randomly divided into two groups. Group A (n=100) underwent endoscopic IMA harvesting. In group B (n=99) IMAs were harvested using an open conventional approach. In both groups during surgery side branches of the IMA were isolated and identified.
RESULTS: The 2 groups, were comparable with regard to mean age and age distribution, male sex (56% versus 63%, respectively), cause of death and coronary risk factors including smoking, diabetes, dyslipidemia and hypertension.
24 of 199 cadavers (12%) had a lateral costal branch. The LIMA arose from the third part of the subclavian artery in 6%, and from the thyrocervical trunk in 7% of the cadavers. there were a significantly higher number of unligated side branches in group B, compared with group A (14 branches versus 3 branches, P<0.01).the first intercostal artery and lateral costal artery were found unligated in 3 % and 5% of cadavers in group B whereas no side branch remained unligated in group A. There was no subclavian artery or internal mammary artery injury in either group. Internal mammary vein was damaged in 2% of cadavers in group B.
CONCLUSIONS: The thoracoscopic LIMA harvesting is more accurate in finding and ligating the side branches of internal mammary artery


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