Extrapleural takedown of the internal mammary artery as a pedicle.

Four hundred thirty-three patients underwent coronary bypass grafting using both internal mammary artery (IMA) and saphenous vein graft. In 233 patients the IMA was exposed with a conventional technique (group 1), whereas in the remaining patients the IMA was harvested leaving the pleura intact and performing an associated lysis of the endothoracic fascia (group 2). Postoperative course and complications of these groups were studied and compared in a period of time ranging from 8 to 28 months. Postoperatively, the blood transfused was significantly less in group 2 patients than in group 1; group 2 also had a reduction of surgical reexploration. Pleural effusion and hemidiaphragm impairment were infrequent or absent in group 2 patients, whereas pericarditis, severe postoperative chest pain, and respiratory insufficiency were noted only in group 1 patients. Our data suggest that extrapleural access without pleurotomy may be preferred owing to its low rate of chest wall complications.