Impacts of Skeletonized Bilateral Internal Mammary Artery Bypass Grafting on the Risk of Deep Sternal Wound Infection.

This single-center study aimed to evaluate the incidence of deep sternal wound infection (DSWI) following skeletonized bilateral internal mammary artery (BIMA) harvest in a Chinese cohort. Using propensity score matching, this study also provided a present-day assessment of the impacts of skeletonized BIMA grafting versus skeletonized single internal mammary artery (SIMA) grafting on early outcomes.From January 2014 to December 2017, 2403 eligible patients were entered into either a BIMA group (n = 368) or a SIMA group (n = 2035). The incidence of DSWI was recorded. Analysis of early outcomes was further performed for propensity score-matched (1:1) cohorts.The BIMA group received a similar incidence of DSWI as did the SIMA group (1.6% versus 0.9%, P = 0.247). No significant differences between subgroup diabetic-BIMA, subgroup nondiabetic-BIMA, subgroup diabetic-SIMA, and subgroup nondiabetic-SIMA were found regarding the incidence of DSWI (2.0%, 1.4%, 1.0%, and 0.7%, respectively; P > 0.05 between groups). After matching, treatment type (skeletonized BIMA grafting versus skeletonized SIMA grafting) was not an independent risk factor for postoperative DSWI (OR = 1.309, 95% CI 0.897-2.714, P = 0.704) or predictors of other early outcomes. Additionally, the two matched groups shared similar early outcomes (including postoperative DSWI), regardless of whether or not the merger with diabetes (all P > 0.05).Skeletonized BIMA harvest as compared with skeletonized SIMA harvest was not associated with an increased risk of DSWI, regardless of whether or not the merger with diabetes. Patients with skeletonized BIMA grafting received similar surgical mortality and major postoperative morbidity as did matched patients with skeletonized SIMA grafting.

[1]  Joseph P Desimone,et al.  Coronary Revascularization With Single Versus Bilateral Mammary Arteries: Is It Time to Change? , 2018, The Annals of thoracic surgery.

[2]  P. Hsu,et al.  Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease. , 2018, International heart journal.

[3]  Joseph P Desimone,et al.  Does Use of Bilateral Internal Mammary Artery Grafting Reduce Long-Term Risk of Repeat Coronary Revascularization?: A Multicenter Analysis , 2017, Circulation.

[4]  H. Lai,et al.  Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection. , 2017, International heart journal.

[5]  K. Miyauchi,et al.  Coronary Artery Disease and Type 2 Diabetes Mellitus. , 2017, International heart journal.

[6]  Chunsheng Wang,et al.  Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center , 2017, Journal of Cardiothoracic Surgery.

[7]  D. Altman,et al.  Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts. , 2016, The New England journal of medicine.

[8]  D. Altman,et al.  Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. , 2016, The Journal of thoracic and cardiovascular surgery.

[9]  L. R. Sajja.  Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting. , 2015, International journal of surgery.

[10]  F. Mohr,et al.  Bilateral internal mammary artery grafting: rationale and evidence. , 2015, International journal of surgery.

[11]  Ramanan Umakanthan,et al.  Barriers to the universal adoption of bilateral internal mammary artery grafting. , 2015, International journal of surgery.

[12]  I. Belenkie,et al.  Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. , 2014, The Journal of thoracic and cardiovascular surgery.

[13]  Y. Mehta,et al.  International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. , 2014, American journal of infection control.

[14]  T. Vassiliades,et al.  Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients. , 2012, The Annals of thoracic surgery.

[15]  G. Mannam,et al.  Reduction of sternal wound infections in diabetic patients undergoing off-pump coronary artery bypass surgery and using modified pedicle bilateral internal thoracic artery harvest technique. , 2012, The Journal of thoracic and cardiovascular surgery.

[16]  P. Kurlansky,et al.  Bilateral internal thoracic artery grafting improves long-term survival in patients with reduced ejection fraction: a propensity-matched study with 30-year follow-up. , 2012, The Journal of thoracic and cardiovascular surgery.

[17]  Sean M. O'Brien,et al.  Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. , 2012, The Journal of thoracic and cardiovascular surgery.

[18]  M. Mack,et al.  Complex coronary anatomy in coronary artery bypass graft surgery: impact of complex coronary anatomy in modern bypass surgery? Lessons learned from the SYNTAX trial after two years. , 2011, The Journal of thoracic and cardiovascular surgery.

[19]  Sean M. O'Brien,et al.  Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery: Analysis of the Society of Thoracic Surgeons National Cardiac Database , 2009, Circulation.

[20]  C. Reid,et al.  Clinical characteristics and early mortality of patients undergoing coronary artery bypass grafting compared to percutaneous coronary intervention: insights from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventional Group (MIG) Registries. , 2009, Heart, lung & circulation.

[21]  S. Davoodi,et al.  Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality , 2007, BMC infectious diseases.

[22]  J. Dunning,et al.  Is skeletonised internal mammary harvest better than pedicled internal mammary harvest for patients undergoing coronary artery bypass grafting? , 2005, Interactive cardiovascular and thoracic surgery.

[23]  F. Tomai,et al.  The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization. , 2005, The Journal of thoracic and cardiovascular surgery.

[24]  C. Lindholm,et al.  Surgical-site infections within 60 days of coronary artery by-pass graft surgery. , 2004, The Journal of hospital infection.

[25]  C. Peniston,et al.  Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. , 2003, The Journal of thoracic and cardiovascular surgery.