Chest
Volume 101, Issue 2, February 1992, Pages 327-330
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Clinical Investigations
Postoperative Pleural Changes after Coronary Revascularization: Comparison Between Saphenous Vein and Internal Mammary Artery Grafting

https://doi.org/10.1378/chest.101.2.327Get rights and content

Coronary artery bypass grafting (CABG) is commonly performed with a saphenous vein graft (SVG) and/or an internal mammary artery graft (IMA). We hypothesized that there would be a higher incidence of pleural changes after CABG in patients who underwent IMA grafting because pleurotomy is usually performed. In the present study, the pre and the 6th postoperative day chest roentgenograms of 122 patients who received CABG were reviewed. The incidence of effusion in the patients who received only SVG was 43 percent (23/54) and did not differ significantly (p>0.05) from the incidence in the patients who also had IMA 41 percent (28/68). Almost all of the patients (43/51) had unilateral left-sided pleural effusions. Most of the effusions were small and did not require treatment. The incidence of effusion was not higher in patients with enlargement of their cardiac silhouette or atelectasis and was not related to the presence of chest tubes. The incidence of pleural thickening was higher in the IMA group (49 percent) than in the SVG group (31 percent) but the difference did not achieve statistical significance (p>0.05). We conclude that there is a high (~40 percent) incidence of small effusions and thickening after CABG. The incidence of pleural effusion and pleural thickening do not appear to be influenced by the type of surgery (IMA vs SVG). We speculate that the effusions are due to pericardial inflammation.

Section snippets

METHODS

We reviewed the operative report from the patients who underwent elective CABG between May 1984 and May 1986 at the Instituto do Coracao of the Faculty of Medicine of the University of Sao Paulo and selected 122 male patients for further study. Fifty-four patients (SVG group) had only SVG grafting and did not have excessive manipulation of their pleura. Sixty-eight patients (IMA group) had received at least one IMA graft in addition to the SVG grafts and had been subjected to pleurotomy.

A

RESULTS

The characteristics of the two groups were very comparable (Table 1). The only significant difference (p<0.05) was in age, but this was not felt to be clinically important. Most of the patients (112, 92 percent) were in functional class 1 while only 10 (8 percent) were in class 2 or 3.7

DISCUSSION

The present study as well as several previous studies8, 9, 10, 11 demonstrate that there is a high incidence of pleural changes after IMA grafting.

The incidence of pleural effusion in the present series is 42 percent. Most of the effusions are small and unilateral on the left. The effusions do not appear to be related to an enlarged cardiac silhouette, atelectasis or the placement of a chest tube. The incidence reported in the present series is comparable to that which has been reported by

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