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Published on: November 19, 2019
[Does the bilateral internal thoracic artery harvesting increase wound infection?]
1Department of Thoracic and Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Japan.
Insights
Bilateral internal thoracic artery (BITA) harvesting is as safe as single internal thoracic artery (SITA) harvesting for preventing wound infections in coronary artery bypass grafting (CABG) patients, including those with diabetes mellitus.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Infections
Background:
- Coronary artery bypass grafting (CABG) frequently utilizes internal thoracic artery (ITA) grafts.
- The choice between bilateral ITA (BITA) and single ITA (SITA) harvesting techniques may influence postoperative wound infection rates.
Purpose of the Study:
- To compare the incidence of wound infections following CABG surgery based on whether bilateral or single ITA harvesting was performed.
- To identify risk factors associated with wound infections in CABG patients.
Main Methods:
- A retrospective study of 234 consecutive CABG cases (January 2004-December 2008) comparing BITA (n=180) and SITA (n=54) harvesting.
- The Harmonic Scalpel with skeletonization technique was employed for all ITA dissections.
- Multivariate analysis was used to determine independent risk factors for wound infection.
Main Results:
- Overall wound infection rates were 6.1% for BITA and 3.7% for SITA; deep sternal infection rates were 1.1% for BITA and 1.9% for SITA, with no significant differences.
- In diabetic patients (n=113), wound infection rates were 6.6% for BITA and 4.5% for SITA, and deep sternal infection rates were 2.2% for BITA and 0% for SITA, also showing no significant difference.
- Independent risk factors for wound infection included emergency surgery, hypertension, congestive heart failure, and reoperation for bleeding.
Conclusions:
- Bilateral ITA harvesting using the skeletonized technique is a safe alternative to single ITA harvesting regarding wound infection risk in CABG patients.
- This safety profile extends to patients with diabetes mellitus, suggesting BITA can be utilized in this population.
- Identifying and managing risk factors like emergency status and comorbidities is crucial for minimizing wound infections post-CABG.
Abstract:
The aim of this study is to compare the frequency of wound infection between bilateral and single internal thoracic artery (ITA) harvesting in coronary artery bypass grafting (CABG) cases. Two hundreds and thirty-four consecutive CABG cases performed harvesting either bilateral ITA (BITA) or single ITA (SITA) from January 2004 to December 2008, with or without concomitant surgery were studied. Harmonic Scalpel was used for the harvesting with skeletonization technique. The cases were divided into 2 groups: BITA group (n = 180) and SITA group (n = 54). The frequencies of wound infection were 3.7% in SITA group and 6.1% in BITA group. As to deep sternal infection, they were 1.9% in SITA group and 1.1% in BITA group. There was no significant difference between the 2 groups. Multivariate analysis of all patients showed that emergency cases, hypertension, congestive heart failure, and reopening for bleeding were identified as independent risk factors for wound infection. There were 113 diabetes mellitus (DM) patients out of all patients ; SITA group (n = 22) and BITA group (n = 91). Their wound infection rates were 4.5% and 6.6%, and those of deep sternal infection were 0% and 2.2%, respectively. There was no significant difference between them. In conclusion, BITA harvesting with skeletonized technique may be used as safely as SITA harvesting even in DM patients.
