Clinical Effects of Pleurotomy on Postoperative Outcomes of Patients Undergoing On-Pump Coronary Artery Bypass Grafting with Skeletonized Left Internal Thoracic Artery

Abstract

Purpose: To evaluate the clinical impact of pleurotomy during skeletonized internal thoracic artery (ITA) harvesting in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods: Consecutive patients (n = 758) who underwent CABG with skeletonized ITA were divided into 2 groups according to pleural integrity: open pleura (OP) and closed pleura (CP). Propensity score matching was performed after retrospective data extraction. The measured outcomes were postoperative pulmonary and hemorrhagic complications, 30-day mortality, and duration of hospital stay. Results: Among 236 propensity score–matched pairs, there was no statistically significant difference between the 2 groups in terms of first 30-day mortality (OP, n = 7 [3%]; CP, n = 5 [2.5%]), blood product use (OP, 0.90 ± 0.71; CP, 0.74 ± 0.7), or median duration of hospital stay. The incidence of postoperative pleural effusion, thoracentesis, prolonged mechanical ventilation, respiratory failure, excessive drainage, cardiac tamponade, and reexploration and the number of patients requiring transfusion were similar in both groups. Conclusion: The clinical effect of pleural protection or pleurotomy on postoperative outcomes is limited in patients undergoing on-pump CABG with skeletonized ITA.