Sternal wound infections and use of internal mammary artery grafts

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

“…Intraoperative risk factors include use of BIMA grafts [1,11,64,72,81,86,91,92], prolonged duration of surgery, perfusion time and aortic cross clamp time [11, 13, 72, 77, 79-81, 86, 95-97], redo cardiac surgery and reoperation [12,58,59,64,87,90,[101][102][103][104][105].…”

“…The maintenance of physiologic blood glucose levels is an important strategy to decrease DSWI rate. Diabetes mellitus has been established as an independent risk factor for postoperative surgical wound infection, with infection rates two to five times more prevalent than in non-diabetic population [1, 11-13, 59, 64, 71-85, 126] Diabetic patients undergoing cardiac surgical procedures, before use of IV insulin, were more likely to have worse short-and long-term survival and higher rates of DSWI [33,71,72,93,[127][128][129][130][131]. Furthermore, post-sternotomy mediastinitis in diabetic patients after cardiac surgery increases operative mortality 2-to 3-fold [34].…”

Left Internal Thoracic Artery Composite Grafting with the Right Internal Thoracic Versus Radial Artery in Coronary Artery Bypass Grafting

“…[20][21][22] This is partly attributed to the higher incidence of deep sternal wound infection and mediastinitis in patients with severe chronic diabetes, old age, low cardiac output, and conditions of poor peripheral perfusion that received BITA bypass grafts. 23,24 Concerns regarding these risks have also been reflected in the present study by the tendency to use RITA grafts in the younger and healthier patients with reasonably longer anticipated life expectancy more selectively. As a result, the RA grafts tended to be used more frequently in diabetics and elderly patients as shown in Table 1.…”

Sternal Wound Infection Prediction Scale: A test of the reliability and validity

“…Use of the internal mammary artery (IMA) as a graft for coronary lesions has become relatively common because patency rates are longer than for saphenous vein grafts (Uva et al, 1998). Grossi et al (1991) found that the incidence of sternal wound infections increased with the use of a single IMA, and increased further with the use of bilateral IMA on diabetic patients. Arnold (1972) mapped the blood supply to the sternum in 1972, and described the blood supply to the sternum as limited to the periosteal plexus which derives blood supply from the IMA.…”