Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients.
BACKGROUND
Coronary artery bypass graft surgery is superior to percutaneous intervention in diabetic patients with multivessel disease. The use of bilateral internal thoracic arteries (BITA) may provide better long-term graft patency, but the risk of postoperative deep sternal wound infection has limited its use in diabetic patients. However, studies have reported conflicting results, and require systematic evaluation.


METHODS
MEDLINE, EMBASE, World of Science, and the Cochrane library were searched for randomized controlled trials and observational studies comparing the incidence of deep sternal wound infection in diabetic patients undergoing either left internal thoracic artery (LITA) or BITA harvest. We used random effect models to compare risk ratios within groups.


RESULTS
One randomized controlled trial and 10 observational studies (126,235 diabetic patients: 122,465 LITA, 3,770 BITA) met inclusion criteria. Deep sternal wound infection occurred in 3.1% and 1.6% for the BITA and LITA cohorts, respectively. The risk ratio for deep sternal wound infection development was 1.71 (1.37 to 2.14) for BITA compared with LITA. Patients who underwent skeletonized BITA harvest had a similar risk of deep sternal wound infection compared with LITA (0.9 [0.42 to 2.09]), although pedicled harvest demonstrated increased risk (1.77 [1.4 to 2.23]). Early mortality was comparable in the LITA cohort (2.5%) and the BITA cohort (2.3%; p = 0.8).


CONCLUSIONS
The risk of deep sternal wound infection can be minimized in diabetic patients undergoing coronary artery bypass graft surgery by performing ITA harvested in a skeletonized manner with meticulous attention to preserving sternal blood flow. Pedicled harvest is to be discouraged when utilizing both ITA owing to a significant increase in the risk of postoperative deep sternal wound infection.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55901, USA. salildeo@yahoo.co.in
Salil V
SV
Deo
Ishan K
IK
Shah
Shannon M
SM
Dunlay
Patricia J
PJ
Erwin
Chaim
C
Locker
Salah E
SE
Altarabsheh
Barry A
BA
Boilson
Soon J
SJ
Park
Lyle D
LD
Joyce
D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D003920:Diabetes Mellitus; D014943:Global Health; D006801:Humans; D015994:Incidence; D008323:Mammary Arteries / Q000637:transplantation*; D012307:Risk Factors; D013249:Sternum; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D020858:Tissue and Organ Harvesting