Effect of Skeletonization of the Internal Thoracic Artery for Coronary Revascularization on the Incidence of Sternal Wound Infection

Saso, Srdjan; James, David; Vecht, Joshua A.; Kidher, Emaddin; Kokotsakis, John; Malinovski, Vitali; Rao, Christopher; Darzi, Ara; Anderson, Jon R.; Athanasiou, Thanos

doi:10.1016/j.athoracsur.2009.08.018

Cited by 81 publications

(61 citation statements)

References 32 publications

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“…Saso et al [19] demonstrated that skeletonization of ITA in patients undergoing CABG was associated with a reduced incidence of deep sternal infection (OR 0.41, 95% CI 0.26 to 0.64). This effect was even more evident when the specific analysis of diabetic patients (OR 0.19, 95% CI from 0.1 to 0.34).…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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Section: Discussionmentioning

confidence: 99%

“…Several studies have shown favorable results to the use of skeletonized ITA [19][20][21]. Saso et al [19] demonstrated that skeletonization of ITA in patients undergoing CABG was associated with a reduced incidence of deep sternal infection (OR 0.41, 95% CI 0.26 to 0.64).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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show abstract

“…Saso et al [20] demonstrated that skeletonization of ITA in patients undergoing CABG was associated with reduced incidence of deep sternal infection (OR 0.41, 95% CI 0.26 to 0.64) and this effect was even more evident when the specific analysis of diabetic patients (OR 0.19, 95% CI from 0.1 to 0.34).…”

Section: Discussionmentioning

confidence: 98%

“…In other words, the skeletonized ITA was an independent protective factor for postoperative mediastinitis in elderly. Several studies have shown favorable results to the use of skeletonized ITA [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Artéria torácica interna esqueletizada está associada a menores taxas de mediastinite em idosos submetidos à cirurgia de revascularização miocárdica

Sá¹,

Santos²,

Figueiredo³

et al. 2011

Rev Bras Cir Cardiovasc

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Artéria torácica interna esqueletizada está associada a menores taxas de mediastinite em idosos submetidos à cirurgia de revascularização miocárdicaSkeletonized internal thoracic artery is associated with lower rates of mediastinitis in elderly undergoing coronary artery bypass grafting surgery Abstract Background and Objectives: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify which option of harvesting internal thoracic artery (ITA), pedicled or skeletonized, is associated with lower rates of mediastinitis after coronary artery bypass grafting surgery (CABG) in elderly, in the Division of Cardiovascular Surgery of PROCAPE.Methods: Retrospective study of 160 elderly who underwent consecutive CABG between May 2007 and June 2011. Eleven preoperative variables, four intraoperative variables and eight postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated between two groups: CABG with skeletonized ITA (n=80) and pedicled ITA (n=80). Univariate and multivariate logistic regression analyses were applied.Results: The incidence of mediastinitis was 6.8% (n=11), with a lethality rate of 54.5% (n=6). The skeletonized ITA group were more exposed than pedicled ITA group to obesity (n=12 vs. n=4; 15% vs. 5%; P=0.035) and multiple transfusions (n=25 vs. n=11; 31.2% vs. 13.7%; P=0.008). The pedicled ITA group presented a greater risk of mediastinitis after CABG than skeletonized ITA group (n=10 vs. n=1; 12.5% vs. 1.2%; Unadjusted OR 11.3; 95% CI 1.4 -241.5; P=0.008). In multivariate analysis, this difference maintained statistically significant (Adjusted OR 5.2; 95% CI 1.5-495.8; P=0.012), being considered an independent association.Conclusions: We suggest that elderly should be considered for strategies to minimize risk of infection. In elderly that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Elderly should always be considered for use of skeletonized ITA. 618Sá MPBO, et al. -Skeletonized internal thoracic artery is associated with lower rates of mediastinitis in elderly undergoing coronary artery bypass grafting surgery Bras Cir Cardiovasc 2011;26(4):617-23 Rev

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“…Nevertheless, selection of patients for BIMA grafting should be performed cautiously, particularly when performing surgery through a standard median sternotomy incision. This is primarily related to the well-demonstrated risk for sternal wound infection after BIMA grafting in patients with diabetes, obesity, and other comorbidities [96][97][98][99][100]. However, BIMA grafting can be performed safely without significant increased risk for sternal wound infection as has been frequently demonstrated [24,98,100,101].…”

Section: Bilateral Internal Mammary Artery Conduitsmentioning

confidence: 99%