Anterior intercostal nerve damage after coronary artery bypass graft surgery with use of internal thoracic artery graft

Ann Thorac Surg. 2000 May;69(5):1455-8. doi: 10.1016/s0003-4975(00)01186-3.


Background: The prevalence of intercostal nerve damage associated with coronary artery bypass graft-internal thoracic (mammary) artery surgery is unknown.

Methods: A total of 37 consecutive patients with coronary artery bypass graft surgery (all with left internal thoracic artery graft) who were attending a cardiac-related exercise program underwent a thorough examination. Nerve damage was considered to be "definite" in the presence of two consistent and well-demarcated sensory abnormalities over the anterior chest wall within the T1 to T6 anterior intercostal nerve territory, and was considered "possible" in the presence of one such abnormality.

Results: Definite nerve damage was detected in 73% of the subjects, and possible nerve damage was found in another 11% at the site of internal thoracic artery harvesting. Protracted postoperative pain or unpleasant sensations, usually subsiding by 4 months, were reported by recollection by 81% of the subjects. Overall, the prevalence of persistent pain in those with definite nerve damage 5 to 28 months after surgery was 15%.

Conclusions: Intercostal nerve damage seems to occur in three-quarters of all patients undergoing coronary artery bypass graft-internal thoracic artery surgery. A significant minority may continue to experience bothersome chronic chest wall pain.

MeSH terms

  • Aged
  • Chest Pain / etiology
  • Humans
  • Intercostal Nerves / injuries*
  • Internal Mammary-Coronary Artery Anastomosis / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications