Cardiac arrhythmias in CABG patients having left internal mammary artery harvested by skeletonized vs. pedicled methods: A systematic review

Background CABG is commonly performed surgery for management of coronary artery disease. The left internal mammary artery (LIMA) is considered the best graft for coronary artery bypass grafting (CABG) in terms of long-term patency and clinical outcome. The mammary artery can be harvested using two techniques; pedicled and skeletonized approach. The decision between skeletonized and pedicled has its impact as each has been associated with its pros and cons. Aim The objective of this systematic review is to assess and summarize the existing literature on arrhythmias occurrence in CABG patients with consideration of the left internal mammary artery-harvesting techniques skeletonised vs pedicled. Methodology A comprehensive search conducted for the studies, previous trials and researches in the available electronic databases, including MEDLINE, Embase, Open Athens and the Cochrane Library, using various combination of MeSH terms and keywords related to "coronary artery bypass grafting”, “left internal mammary artery", "skeletonized", "pedicled", and "cardiac arrhythmias". Randomised controlled trials, observational studies, and case control studies comparing the incidence of cardiac arrhythmias between skeletonized and pedicled LIMA harvesting techniques were included. The primary endpoint measure was the incidence of any cardiac arrhythmia, including atrial fibrillation, ventricular tachycardia, and other rhythm disturbances. Result the literature search result after using the predefined eligibility criteria, yielded a (12) studies. These are included in this systematic review. Patient data were collected from (6,521) patients all of whom underwent coronary artery bypass surgery with either skeletonized or pedicled left internal mammary artery harvesting. Analysis of the combined studies showed that a significantly lower incidence of cardiac arrhythmias occurred in the skeletonized LIMA harvesting group than in the pedicled. At 12% to 38% in the skeletonized group vs 18% up to 47% for the pedicled.