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Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting
Aziz U Momin1, Ranjit Deshpande, James Potts
1Cardiothoracic Department, King's College Hospital, London, United Kingdom. aziz.momin@kcl.ac.uk
Insights
Bilateral internal thoracic artery (BITA) bypass grafting is safe for diabetic patients, showing no increased sternal complications compared to single grafts. This study challenges the perception that BITA increases infection risk in insulin-dependent diabetics.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Diabetic Complications
Background:
- Bilateral internal thoracic artery (BITA) bypass grafts offer medium-term advantages over single internal thoracic artery (SITA) grafts, especially for diabetic patients.
- Surgeons often avoid BITA in diabetics due to perceived higher sternal complication rates.
- This study investigates the actual incidence of sternal infections with BITA versus SITA in diabetic patients.
Purpose of the Study:
- To assess the validity of avoiding BITA surgery in diabetic patients.
- To compare sternal infection rates between BITA and SITA grafts in insulin-dependent diabetics.
- To evaluate the risk of sternal complications associated with BITA grafting in this population.
Main Methods:
- Retrospective analysis of 7,581 coronary artery bypass graft (CABG) patients over 10 years.
- Focus on 922 diabetic patients, including 261 insulin-dependent diabetes mellitus (IDDM) patients.
- Comparison of sternal wound complication rates between 166 SITA and 95 BITA grafts in IDDM patients.
Main Results:
- No significant differences in gender, angina, dyspnea, ventricular function, or anastomoses between SITA and BITA groups in IDDM.
- Superficial sternal infection rate was 6.6% for SITA vs. 1.1% for BITA (p=0.04).
- Deep sternal infection and dehiscence rates were similar between SITA (1.2%) and BITA (3.2%) groups (p=0.27 for both).
Conclusions:
- The study data do not support the perception of increased sternal complications with BITA grafting in insulin-dependent diabetic patients.
- BITA grafting appears to be a safe option for IDDM patients regarding sternal wound complications.
- Findings suggest current surgical practice regarding BITA avoidance in diabetics may be overly cautious.
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.
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