Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether pleurotomy during internal mammary artery (IMA) harvest increases post-operative pulmonary complications. Altogether, 154 papers were found using the reported search, of which 8 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that all patients undergoing cardiac surgery suffer a significant deterioration in pulmonary function and chest radiograph appearance post-operatively. Pleurotomy seems to compound this with increased rates of atelectasis and pleural effusions, although no impact on clinical outcome or length of hospital stay has been demonstrated.