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The internal thoracic artery (ITA) is regarded as the conduit of choice for coronary revascularisation. When anastomosed to the left anterior descending artery, it confers a 10% survival benefit at ten years.1 Studies have identified a risk of pulmonary complications following ITA harvest attributed to parenchymal trauma, pleural effusion and atelectasis as a result of pleurotomy. Maintaining pleural integrity during ITA harvest improves respiratory mechanics by minimising injury to the lung.2 However, the advantage of ‘opening’ the pleura is that a large swab can be packed into the chest, thereby preventing the inflated lung from obscuring the operative field. This technique cannot be used if the pleura is left intact.
We have devised a simple adjunct to prevent lung expansion into the surgical field by using two artery forceps clipped together at right angles (Fig 1). This device enables a swab to be used to splint the lung away from the operative site and yet remain securely fixed during the ventilatory cycle.
This technique allows pleural integrity to be maintained during ITA harvest without compromising surgical access. The benefits of maintaining an intact pleura include the potential reduction in postoperative respiratory dysfunction, the attenuation of haemothorax, the prevention of ipsilateral pleurodesis and the elimination of chest tube thorascostomy requirement, which is not only painful but impairs the patient’s ability to take deep breaths. A simple modification of the current sternal retractor used could be the next evolution of this technique (Fig 2).