title: Skeletonized versus pedicled bilateral internal mammary artery grafting: outcomes and concerns analyzed through a meta-analytical approach.
abstract: BACKGROUND
  It is suggested that the internal thoracic artery (ITA) harvesting technique influences the incidence of sternal wound infection (SWI) after coronary artery bypass graft (CABG) surgery when both right and left ITAs are used. We conducted a meta-analysis to determine whether there is any difference between skeletonized versus pedicled bilateral ITA in terms of SWI after CABG.
  
  
  METHODS
  We performed a systematic-review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that compared the incidence of SWI after CABG between skeletonized versus pedicled bilateral ITA until May 2014. The principal summary measures were odds ratio (OR) with 95% Confidence Interval (CI) and P values (statistically significant when <0.05). The ORs were combined across studies using weighted DerSimonian-Laird random effects model. Meta-analysis, sensitivity analysis and meta-regression were carried out by using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey).
  
  
  RESULTS
  Eight studies involving 2633 patients (1698 skeletonized; 935 pedicled) met the eligibility criteria. There was no evidence for important heterogeneity of the effects among the studies. The overall OR (95% CI) of SWI showed statistical significant difference in favor to skeletonized ITA (random effect model: OR 0.327; 95% CI 0.217-0.492; P < 0.001). In sensitivity analysis, the difference in favor to skeletonized ITA was observed mainly in the presence of diabetes. In meta-regression, we observed no modulation of the effects.
  
  
  CONCLUSIONS
  When both ITAs are used, the skeletonized technique appears to reduce the incidence of SWI after CABG in comparison to the pedicled technique.
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil. Electronic address: michel_pompeu@yahoo.com.br.
authors.forename: Michel Pompeu Barros Oliveira
authors.initials: MP
authors.lastname: Sá
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil.
authors.forename: Paulo Ernando Ferraz
authors.initials: PE
authors.lastname: Cavalcanti
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Henrique José
authors.initials: HJ
authors.lastname: de Andrade Costa Santos
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Artur Freire
authors.initials: AF
authors.lastname: Soares
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Rodrigo Gusmão
authors.initials: RG
authors.lastname: Albuquerque Miranda
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Mayara Lopes
authors.initials: ML
authors.lastname: Araújo
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil.
authors.forename: Ricardo Carvalho
authors.initials: RC
authors.lastname: Lima
mesh_terms: D048909:Diabetes Complications; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D056346:Sternotomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control
keywords: Coronary artery bypass; Mammary arteries; Meta-analysis; Surgical wound infection