Related Experiment Video
Updated: May 29, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients
Michel Pompeu Barros de Oliveira Sá1, Evelyn Figueira Soares, Cecília Andrade Santos
1Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Faculty of Medical Sciences, University of Pernambuco, Recife, Brazil. michel_pompeu@yahoo.com.br
Insights
Harvesting techniques for internal thoracic artery (ITA) grafts significantly impact mediastinitis risk in diabetic patients undergoing coronary artery bypass grafting (CABG). Skeletonized ITA harvesting is recommended to reduce infection complications.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Infectious Disease Epidemiology
Background:
- Mediastinitis is a severe complication post-median sternotomy, associated with high morbidity and mortality.
- Diabetes mellitus is a recognized risk factor, increasing surgical caution in cardiovascular procedures.
Purpose of the Study:
- To identify risk factors for mediastinitis in diabetic patients undergoing coronary artery bypass grafting (CABG).
- To evaluate the impact of unilateral internal thoracic artery (ITA) harvesting techniques on mediastinitis risk.
Main Methods:
- Retrospective analysis of 157 diabetic patients undergoing CABG between May 2007 and April 2010.
- Evaluation of preoperative, intraoperative, and postoperative variables using univariate and multivariate logistic regression.
Main Results:
- The incidence of mediastinitis was 7%, with a 36.1% mortality rate.
- Pedicled ITA harvesting (OR 7.64, P=0.048) was identified as an independent risk factor for mediastinitis in multivariate analysis.
- Postoperative renal complications and re-operation were also associated with increased risk.
Conclusions:
- Diabetic patients require specific strategies to minimize infection risk after sternotomy.
- The method of ITA harvesting is critical; skeletonized ITA is associated with lower mediastinitis risk compared to pedicled ITA in diabetics.
- Recommend routine use of skeletonized ITA in diabetic patients undergoing CABG.
Background:
Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons.
Objective:
To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE.
Methods:
Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied.
Results:
The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA.
Conclusions:
We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA.
Related Concept Videos
01:15Thoracic Aorta
01:19Veins of Thorax
The azygos vein, positioned just right of the midline and anterior to the vertebral column, begins at the junction of the right ascending lumbar and subcostal veins, terminating in the superior vena cava. This vein drains blood from the right side of the thoracic wall, thoracic viscera, and posterior abdominal wall.
The...