title: Skeletonized internal thoracic artery is associated with lower rates of mediastinitis in elderly undergoing coronary artery bypass grafting surgery.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. University of Pernambuco – UPE, Recife, PE, Brazil. michel_pompeu@yahoo.com.br
authors.forename: Michel Pompeu Barros de
authors.initials: MP
authors.lastname: Oliveira Sá
authors.forename: Cecília Andrade
authors.initials: CA
authors.lastname: Santos
authors.forename: Omar Jacobina
authors.initials: OJ
authors.lastname: Figueiredo
authors.forename: Renato Oliveira Albuquerque
authors.initials: RO
authors.lastname: Lima
authors.forename: Paulo Ernando
authors.initials: PE
authors.lastname: Ferraz
authors.forename: Alexandre Magno Macário Nunes
authors.initials: AM
authors.lastname: Soares
authors.forename: Pablo César Lustosa Barros
authors.initials: PC
authors.lastname: Bezerra
authors.forename: Wendell Nunes
authors.initials: WN
authors.lastname: Martins
authors.forename: Ricardo de Carvalho
authors.initials: Rde C
authors.lastname: Lima
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000502:physiology / Q000637:transplantation*; D008480:Mediastinitis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*