Incidence of Sternal Infection in Diabetic Patients Undergoing Bilateral Internal Thoracic Artery Grafting

Momin, Aziz; Deshpande, Ranjit; Potts, James L.; El‐Gamel, Adam; Marrinan, Michael T.; Omigie, Joseph; Desai, Jatin

doi:10.1016/j.athoracsur.2005.04.061

Cited by 54 publications

(49 citation statements)

References 22 publications

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“…Moreover, previous studies have also failed to find a significant increase in SWI with BIMA grafting in diabetics. 21,22 Differences reported in the literature may likely be due less to statistical variance than to surgical technique. All the IMAs in this study were harvested with a skeletonized technique, which has been demonstrated to better preserve sternal blood flow [23][24][25] and to reduce the risk of SWI.…”

Section: Discussionmentioning

confidence: 57%

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

et al. 2012

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Background— The prevalence of diabetes mellitus is increasing at an unprecedented rate, affecting nearly 8% of the population. Previous studies have demonstrated a potential benefit for surgical over interventional revascularization in this group of patients. Similarly, studies have shown the superiority of bilateral internal mammary artery (BIMA) grafting over single internal mammary artery (SIMA) grafting in select populations. However, concerns about sternal wound infection have discouraged the use of BIMA grafting in diabetics. Therefore, we studied the long-term results of BIMA versus SIMA grafting in a large population of diabetic patients in whom BIMA grafting was broadly applied. Methods and Results— Between February 1972 and May 1994, 1107 consecutive diabetic patients underwent coronary artery bypass grafting with either SIMA (n=646) or BIMA (n=461) grafting. Optimal matching with the propensity score was used to create matched SIMA (n=414) and BIMA (n=414) cohorts. Cross-sectional follow-up (6 weeks to 30.1 years; mean, 8.9 years) determined long-term survival. There was no difference in operative mortality, sternal wound infection, or total complications between matched SIMA and BIMA groups (operative mortality, 10 of 414 [2.4%] versus 13 of 414 [3.1%]; P =0.279; sternal wound infection, 7 of 414 [1.7%] versus 13 of 414 [3.1%]; P =0.179); total complications, 71 of 414 [17.1%] versus 71 of 414 [17.1%]; P =1.000). Late survival was significantly enhanced with the use of BIMA grafting (median survival: SIMA, 9.8 years versus BIMA, 13.1 years; P =0.001). Use of BIMA was found to be associated with late survival on Cox regression ( P =0.003). Conclusion— Compared with SIMA grafting, BIMA grafting in propensity score–matched patients provides diabetics with enhanced survival without any increase in perioperative morbidity or mortality.

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Section: Discussionmentioning

confidence: 57%

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

et al. 2012

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“…However, they also have suggested that the use pf bilateral internal thoracic artery grafts in patients with type 2 DM, who require the use of insulin, can result in surgical wound major complications. These data are not support by the literature [13].…”

Section: Introductioncontrasting

confidence: 57%

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus

Martins¹,

Santos²,

Tirado³

et al. 2007

Rev Bras Cir Cardiovasc

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Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitusCoronary artery bypass grafting using both internal mammary arteries in patients with diabetes mellitus Abstract Objective: We sought to describe the use of both internal thoracic arteries (ITA) in patients with diabetes mellitus (DM) submitted to a coronary artery bypass grafting (CABG).Method: Between January 1995 to August 2005, 4,569 patients received isolated CABG in our institution. Of the initial population, 1,298 had DM. The median age of the patients was 62 years and total mortality rate was 2.18% (100 patients). Both internal thoracic arteries were used in 700 patients. Patients were divided into two groups: with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double ITA grafting was based on coronary artery anatomy and on the quality of sternum. The later was evaluated during the sternal transsection. When these two factors were considered favorable, we have both ITAs dissected, regardless whether the patient had DM. During the dissection of both internal thoracic arteries, one must take care not to open the pleural spaces.Results: There was a small difference between the two groups in terms of morbidity and mortality.Conclusion: Our data suggests that patients with DM can benefit with the efficient use of both internal thoracic arteries with a small increase in the risk of complications, if its application is carefully indicated.

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“…The independent risk factors for SSI, suggested by other reports and the guidelines of the CDC, were evaluated. [1][2][3][4][5][6][7][8] We also studied the EuroSCORE 22 and postoperative blood glucose levels. 23 Blood glucose levels were usually measured 4-8 times per day, and impaired glucose tolerance was treated with intravenous insulin to maintain the blood glucose levels below 200 mg/dl.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9] In Japan, the incidence of SSI after general and thoracic surgery ranges from 0.5% to 19.4%; 10 however, the incidence of SSI in postdischarge surveillance is especially high. 1,2,9 About 90% of SSIs of sternal wounds are diagnosed after discharge from hospital, although the hospitalization, methods of followup, and defi nitions of SSI, vary in different studies.…”

Section: Introductionmentioning

confidence: 98%

A new hydrocolloid dressing prevents surgical site infection of median sternotomy wounds

et al. 2009

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Incidence of Sternal Infection in Diabetic Patients Undergoing Bilateral Internal Thoracic Artery Grafting

Cited by 54 publications

References 22 publications

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus

A new hydrocolloid dressing prevents surgical site infection of median sternotomy wounds

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