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

Sajja, Lokeswara Rao; Mannam, Gopichand; Dandu, Satya Bhaskara Raju; Sompalli, Sriramulu

doi:10.1016/j.jtcvs.2012.03.024

Cited by 26 publications

(18 citation statements)

References 26 publications

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“…Sparing of the communicating bifurcation of the ITA to the chest wall and preservation of pericardiacophrenic artery branch has been reported to minimize the risk of sternal wound complication in patients receiving P-BITA. 23 In the present study, we could not confirm this hypothesis because data on technical aspects of harvesting technique were not reported. OR, Odds ratio; CI, confidence interval; LL, lower limit; UL, upper limit; P-BITA, pedicled bilateral internal thoracic artery; P-SITA, pedicled single internal thoracic artery; S-SITA, skeletonized single internal thoracic artery; S-BITA, skeletonized bilateral internal thoracic artery; BMI, body mass index; NYHA, New York Heart Association; COPD, chronic obstructive pulmonary disease; PVD, peripheral vascular disease; MI, myocardial infarction; LVEF, left ventricular ejection fraction.…”

Section: Study Limitationsmentioning

confidence: 61%

Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial

Benedetto

Altman

Gerry

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

164

111

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Section: Study Limitationsmentioning

confidence: 61%

Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial

Benedetto

Altman

Gerry

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

164

111

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“…Previous observational studies have reported that the incidence of DSWI following BIMA harvest ranged from 0.6% to 4.2%. 23,24) Recently, a meta-analysis has reported that the incidence of DSWI after BIMA grafting ranged widely from 0.3% to as high as 14%. 25) In the ART, the rate of sternal wound infection was 3.5% for BIMA harvest.…”

Section: Discussionmentioning

confidence: 99%

“…This result agreed with the results of the overwhelming majority of previous studies. 4,5,7,19,[23][24][25][26] Results from this study showed that compared with skeletonized SIMA harvest, skeletonized BIMA harvest did not increase the risk of sternal wound complications regardless of whether or not the merger with diabetes and compared with skeletonized SIMA grafting, skeletonized BIMA grafting did not increase the risks of surgical mortality or major postoperative morbidity. This study serves as additional confirmation and a reminder that the time is right to change our old habits and to adopt a skeletonized approach as the standard technique for IMA harvesting.…”

Section: Impacts Of Bima Grafting On the Risk Of Dswimentioning

confidence: 99%

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

Zhao

Liu

et al. 2020

Int. Heart J.

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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.

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“…Sajja LR, et al [18] found that average age of the patient was 57.8 ± 7.43 years. Omran AS, et al [14] demonstrated that the average age of the patient was 58.5 ± 9.7 years.…”

Section: Discussionmentioning

confidence: 95%

Incidence and Predictor of Post-Operative Wound Infection in Patients Underwent Coronary Artery Bypass Grafting

Gull¹,

Hussain²,

Farogh³

et al. 2018

JCTCD

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Objective: To determine the incidence and predictor of postoperative wound infection in patients underwent coronary artery bypass grafting (CPB). Methods:This was a prospective comparative study of 577 patients who underwent cardiac surgery with (CPB) was conducted at cardiac surgery department of Punjab Institute of cardiology, Lahore from 1st March 2012 to 31st March 2017. Consecutive patients undergoing elective and isolated CABG, both genders age ≥20 years, with normal ejection fraction were included in the study Results: Out of 577 patients of which 166(87.83%) were male while 23(12.16%) were female. The mean age of the patient was 53.23 ± 8.43. Incidence of post-operative wound infection in patients underwent coronary artery bypass grafting (CPB) was 73(12.65%). Common co morbid conditions were hypertension 50%, diabetes mellitus (43.5%), smoking (31.1%), hyperlipidemia (20.3%), prior of stoke (12.2%), Prior Surgery (6.8%) and prior renal failure (4.1%), mean CPB time (61.69 ± 32.27), ICU stay 976.03 ± 31.93), mean Cross clamp time(25.27 ± 19.17mg/dl) and Hospital stay (10.16 ± 5.6 day) were more in WI group. Themortality was found to be high in WI group (23.3%). Logistic regression showed that significantly predicted of the post-operative WI were elder age,diabetes mellitus, smoking, family history of IHD, hyperlipidemia, cardiopulmonary bypass time, ICU stay, hospital stay. Conclusion:We can conclude that wound infected patients are at significantly greater risk of incidence, morbidity and mortality after cardiac surgery.

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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

Cited by 26 publications

References 26 publications

Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial

Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial

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

Incidence and Predictor of Post-Operative Wound Infection in Patients Underwent Coronary Artery Bypass Grafting

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