Optimisation of internal thoracic artery exposure using a simple retraction method for extrapleural dissection.

BACKGROUND 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.' 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.