Abstract:

Aim: was to assess chances of the development of postoperative diaphragmatic dysfunction (DD), depending on methods of coronary artery bypass graft (CABG), by estimation the probability of development of DD according to the side of internal thoracic artery (ITA) harvest.

Materials and methods: evaluation of the mobility of domes of the diaphragm in the early perioc after 3051 CABG operations (with use of ITA) was made. Control group included patients with normal mobility of the diaphragm. Study group included patients with right-sided, left-sided and bilateral DD. Using a logistic regression model we evaluated the influence of the method of CABG (with use of ITA) in the development of DD from the side of the ITA harvest. The model included two ways of CABG - «in situ» and autograft.

Results: there are differences in chances of development of unilateral and bilateral DD, depending on the method of CABG (with use of ITA) and combinations thereof. High possibility of developing DD after CABG with right ITA was observed after CABG «in situ» (OR 5,4; CI 4,3-6,8), and smaller after CABG with ITA autograft (OR 1,8; CI 1,4-2,3). High possibility of DD was observed after CABG with left ITA autograft (OR 3,5; CI 2,2-5,6); after CABG «in situ», there was no DD.

Conclusion: methods of CABG using ITA, «in situ» and autograft, differently affect the mobility of the diaphragm from the side of surgical procedure. Results of the study indicate a high probability of DD after CABG with left ITA autograft and right ITA «in situ». It is established that possibility of DD was low in case of CABG with right ITA as autograft and was absent in left ITA «in situ».

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