
==== Front
Indian J Crit Care Med
Indian J Crit Care Med
IJCCM
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
0972-5229
1998-359X
Jaypee Brothers Medical Publishers

10.5005/jp-journals-10071-24739
Letter to the Editor
Author Response: Mirror, Mirror on the Wall; He Had a “Bypass” After All!
Shukla Manish P https://orcid.org/0000-0001-7416-4663

Department of Physiotherapy, MGM Institute of Physiotherapy, Chhatrapati Sambhaji Nagar, Maharashtra, India
Manish P Shukla, Department of Physiotherapy, MGM Institute of Physiotherapy, Chhatrapati Sambhaji Nagar, Maharashtra, India, Phone: +91 9960290614, e-mail: manish.shukla20@gmail.com
7 2024
29 6 2024
28 7 708708
Copyright © 2024; The Author(s).
2024
https://creativecommons.org/licenses/by-nc/4.0/ © The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
How to cite this article: Shukla MP. Author Response: Mirror, Mirror on the Wall; He Had a “Bypass” After All! Indian J Crit Care Med 2024;28(7):708.

Keywords

Coronary artery bypass grafting
Internal mammary grafts
Left internal thoracic artery
Pleurotomy
Postoperative pulmonary function
==== Body
pmc Dear Authors,

Thank you for sharing your insightful letter regarding our recently published study, “Effect of Buteyko Breathing Technique as an Adjunct to Routine Physiotherapy on Pulmonary Functions in Patients Undergoing Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial.” We appreciate the thoughtful comments and valid concerns raised in your letter.1

We acknowledge the importance of considering specific surgical details that could influence the interpretation and generalizability of our study findings. Your letter has highlighted several crucial aspects that merit further clarification and discussion.

Pleural integrity during left internal thoracic artery (LITA) harvest: You rightly pointed out the need for clarity regarding the technique employed for the LITA harvest in our study participants. We recognize that pleural opening during LITA harvest can adversely affect postoperative pulmonary mechanics, as demonstrated by the study you cited by Guizilini et al. In our study, we employed the intact pleura technique for LITA harvest whenever possible. However, in cases where incidental pleural opening occurred, we followed standard chest drain management practices to mitigate any potential complications.

Bilateral internal mammary artery (BIMA) harvest: Your concern regarding the potential impact of BIMA harvest on postoperative pulmonary function is well-founded. In our study cohort, the majority of patients underwent single IMA (SIMA) harvesting, as this is the standard practice at our institution. Only a small subset of patients with specific clinical indications underwent BIMA harvesting. We acknowledge that violating both pleural cavities during the BIMA harvest could have influenced the effectiveness of the Buteyko breathing technique, and we should have provided this information in our report.

Graft choice and attrition rates: While our study focused primarily on the postoperative pulmonary function outcomes, your comment regarding the potential influence of graft choice (arterial vs venous grafts) on long-term graft patency and attrition rates is duly noted. We agree that this information could have added valuable context to our study's findings and potential implications for postoperative pulmonary rehabilitation strategies.

We appreciate you taking the time to critically evaluate our study and provide these insightful comments. Your feedback has highlighted the importance of considering and reporting specific surgical nuances, particularly related to pleural integrity, graft choices, and bilateral IMA harvest when evaluating postoperative pulmonary function and rehabilitation strategies in patients undergoing coronary artery bypass grafting (CABG).

Thank you once again for your valuable contribution to the scientific discourse. We appreciate your efforts in advancing our understanding of this important area of study.

Orcid

Manish P Shukla https://orcid.org/0000-0001-7416-4663

Source of support: Nil

Conflict of interest: None
==== Refs
References

1. Magoon R Jose J Kumar M Mirror, Mirror on the Wall; He Had a “Bypass” after All! Indian J Crit Care Med 2024 28 7 706 707
