Comparative Study Between the effect of Skeletonized and Pedicled Internal Thoracic Artery on sternum healing in Patient Undergoing CABG

Background: Myocardial revascularization is performed preferentially with internal thoracic artery grafts. This study aimed to investigate sternal healing over time and the incidence of poor sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized internal thoracic artery. Objectives: (1) comparison of two surgical take-down techniques (skeletonizing vs. standard pedicle harvestation); (2) assessment of sternal healing and wound infection. Method: This study enrolled 50 patients (divided in two groups) who underwent isolated CABG using skeletonized internal thoracic artery (25 patients) and pedicled internal thoracic artery (25 patients) from December 2017 to August 2019. Postoperative assessment was performed on all patients for three months after surgery. In all patients, chest X-ray study was performed after surgery to assess sternal healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: (1) After coronary grafting, assessment of sternum showed significant differences in healing between the two groups. (2) Diabetes mellitus as an independent predictor for superficial wound infection. (3) Pedicled procedure is an important factor associated with superficial wound infection in post-operative period. (4) Skeletonized procedure prolong the operation. (5) Pedicled procedure prolong the ICU and hospital stay.Conclusion: (1) Skeletonization of internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG with internal thoracic artery grafting. (2) Skeletonization of internal thoracic artery conduits prolong the operation time and require more surgical skills. (3) Skeletonization of ITA has better outcome.