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(Circulation. 2000;102:III-307.)
© 2000 American Heart Association, Inc.

Myocardial Protection and Vascular Biology

Novel Method to Enhance Sternal Healing After Harvesting Bilateral Internal Thoracic Arteries With Use of Basic Fibroblast Growth Factor

Atsushi Iwakura, MD; Yasuhiko Tabata, PhD; Manabu Miyao, MS; Makoto Ozeki, BS; Nobushige Tamura, MD; Akio Ikai, MD; Kazunobu Nishimura, MD; Tatsuo Nakamura, MD; Yasuhiko Shimizu, MD; Masatoshi Fujita, MD; Masashi Komeda, MD

From the Department of Cardiovascular Surgery (A. Iwakura, N.T., A. Ikai, K.N., M.K.), Kyoto University Graduate School of Medicine, and the Institute for Frontier Medical Sciences (Y.T., M.M., M.O., T.N., Y.S.) and College of Medical Technology (M.F.), Kyoto University, Kyoto, Japan.

Correspondence to Masashi Komeda, MD, Professor and Chairman, Department of Cardiovascular Surgery, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan 606-8507. E-mail masakom{at}kuhp.kyoto-u.ac.jp

Background—Poor healing of the sternum often limits the use of bilateral internal thoracic arteries (BITAs) in coronary bypass surgery, especially for diabetic patients. We have reported that basic fibroblast growth factor (bFGF) enhanced regeneration of the skull. This study was designed to evaluate the effects of topical use of bFGF on sternal healing after removing the BITAs.

Methods and Results—Forty-five Wistar rats were subjected to median sternotomy and were divided into 3 groups: 15 had the BITAs removed and had a bFGF sheet applied on the posterior table of the sternum (group A), 15 had just the BITAs removed (group B), and 15 had intact BITAs (group C). Five and 10 rats were euthanized 2 and 4 weeks after surgery, respectively, in all 3 groups. Peristernal blood flow, measured with use of a noncontact laser flowmeter, decreased after removal of the BITAs (P<0.001). Four weeks after the surgery, PBF markedly increased only in group A (9.7±1.2, 6.5±0.6, and 8.2±0.5 mL · min^-1 · 100 g^-1 for groups A, B, and C, respectively; P<0.01 by ANOVA). Four weeks after surgery, the following findings were obtained only in group A: (1) nearly completely healed sternum filled with regenerated bone tissue, (2) marked angiogenesis around the sternum, and (3) osteoblasts in an active form around the edge of the sternum.

Conclusions—The results suggest that use of the bFGF sheet offset the sternal ischemia and accelerated sternal healing. This method may help to decrease sternal necrosis in high-risk patients or allow extended use of BITAs in coronary bypass surgery.

Key Words: angiogenesis • blood flow • growth substances