Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.
BACKGROUND
Bilateral internal thoracic artery (BITA) bypass grafts have advantages over single internal thoracic artery (SITA) bypass grafts in the medium term, particularly in diabetics. However, the perceived higher sternal complication rates seen in diabetics have led many surgeons to avoid the use of BITA surgery. The aim of our study was to assess the validity of this approach by assessing the incidence of sternal infections over a 10-year period in one institution.


METHODS
A retrospective analysis was made of our coronary artery bypass graft (CABG) patients over a 10-year period (7,581 patients). Nine hundred and twenty-two of the patients were diabetics (261 insulin-dependent diabetes mellitus [IDDM]). Of the insulin-dependent diabetics, 166 had SITA, and 95 had BITA grafts.


RESULTS
There was no significant difference in this subgroup in terms of gender, preoperative angina, dyspnea class, left ventricular function, and number of distal anastomoses. Comparing the rates of sternal wound complications of SITA and BITA in IDDM are the following: (1) superficial sternal infection, 6.6% in SITA, 1.1% in BITA (p = 0.04); (2) deep sternal infection, 1.2% in SITA, 3.2% in BITA (p = 0.27); (3) sternal dehiscence, 1.2% in SITA, 3.2% in BITA (p = 0.27).


CONCLUSIONS
Our data do not support the perception that BITA grafting increases the risk of sternal complications in insulin-dependent diabetic patients.
Momin
Aziz U
AU
Cardiothoracic Department, King's College Hospital, London, United Kingdom. aziz.momin@kcl.ac.uk
Deshpande
Ranjit
R
Potts
James
J
El-Gamel
Ahmed
A
Marrinan
Michael T
MT
Omigie
Joseph
J
Desai
Jatin B
JB
D000368:Aged; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D013249:Sternum / Q000473:pathology*; D013530:Surgical Wound Infection / Q000145:classification*