الفهرس 
Surgical AnatomyOnly 14 pages are availabe for public view
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Abstract
This prospective randomized comparative study was carried out between January 2011 and May 2013, including 60 patients for whom CABG surgery was performed with overall number of 60 men(100%). We compared two properly-matched groups (30 patients each);
Group (A), included CABG patients submitted to combination pedicled LIMA/RA/SVGS.
Group (B) included patients with sketolenized LIMA±RA/SVGS graft combination.
Preoperative stage of preparation / assessment included standard steps in all patients which started by careful and thorough history taking and clinical examination taking into consideration the patient’s age, sex, risk factors, 12-lead resting ECG) routine investigations (Labs, Plain chest X-rays; echocardiographic examination, coronary angiography, Doppler study for the carotid arteries, and the radial artery, in addition to the modified Allen’s test.
Acceptable degrees of preoperative risk factors were present in both groups. In group A 14 (47%) patients were ex-cigarette smokers versus 18 patients in group B (60 %) (p = NS).
Systemic Hypertension was found in 22 of group A patients (73%); versus 18 in group B (60%) (p = NS). Diabetes Mellitus was present in 19 patients of group A (63%) vs 10 patients (33%) in group B (p = S). Preoperatively, blood sugar level was strictly well- controlled using IV insulin infusion in all patients.
In group A dyslipidemia was discovered in 3 patients (10%); versus 9 of group B patients (30%) (P = NS). Blood cholesterol level was well-controlled (below 250 mg) using oral lipid-lowering drugs in all patients preoperatively.
All patients of both groups were evaluated according to the Euro SCORE system for postoperative mortality. According to that system, score points from 0-2 means low-risk; a score points from 3-5 means medium- risk; while score points 6 plus means a high-risk of perioperative mortality. All patients had a Euro-Score not more than 7.
In group A, the mean number of vessels grafted was 3.27 vs 3.6 grafts in group B (p = .073 the mean duration of surgery was 103.17 minutes for group A patients; versus 115.90 minutes for group B patients (p = 0.090). The mean time for aortic cross clamping (ischemia) was 66.6 minutes for group A cases; versus 81.97 minutes in group A cases (p =0.001 s).
Results were evaluated in the early postoperative period & during hospital stay. No mortality was found in both groups during early postoperative or hospital stay.
The mean period of ICU stay was 2.57 ± 1.30 days for group A cases; vs. 2.50 ± 1.59 days for group B cases (p =0.860), the mean hospital stay time was 8.9 ± 3.4 days for group A patients; vs. 7.8 ± 1.7 days for group B patients (p =0.109).
o ECG changes of new MI (elevated ST segment/pathological Q waves) were noticed in 1 of group A; vs. 2 cases of group B cases (p = 0.561).
o The patients were discharged home safely on combined medications (anticoagulant-vasodilator-B-blocker).
o IABCP was not used in any of patients.
o The mean period for postoperative mechanical ventilation (in hours) was 9.77 ± 2.90 hrs in group A; vs. 8.18 ± 2.68 hrs in group B (p =0.565).
o AF occurred in 2 (6.7%) patients group A vs 2 (6.7%) patients in B (p =1.000)
o ATN occurred in 2 (6.7%) patients group A vs 2 (6.7%) patients in group B (p =1.000).
o Mean drainage in group A was 1030cc vs 1098 cc in group B (p=0.664).
o Mean no of blood units transfused to group a patients was 3.4 units vs 2.6 units in group B (p=0.193) 2 patients were reopened for bleeding in both groups (6.7%) (p=1.000).
o Sternal wound infection or mediastinitis was 6 patients in group A vs 3 patients in group .
o Intractable Arrythmias, CVS Accidents, Prolonged Mechanical Ventilation didn’t occur in either group.
Thus, it was obvious that sIMA grafting did not increase the early mortality nor the morbidity rates after CABG operation however there is significant reduction in chest wall pain and dysesthesia and in improved sternal perfusion by less sternal ischemia . Skeletonization may improve conduit flow but significant increase conduit length that allowing more sequential anastomosis and availability of total arterial revascularization with all its benefits in longer patency and less wounds in the patients.