Related Experiment Video
Updated: May 14, 2026
A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice
Published on: January 23, 2016
Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients
Salil V Deo1, Ishan K Shah, Shannon M Dunlay
1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55901, USA. salildeo@yahoo.co.in
Insights
Diabetic patients undergoing coronary artery bypass graft surgery face a higher risk of deep sternal wound infection with bilateral internal thoracic arteries (BITA) harvest compared to single internal thoracic artery (LITA) harvest. Skeletonized BITA harvest minimizes this risk, unlike pedicled harvest.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Diabetic Complications
Background:
- Coronary artery bypass graft (CABG) surgery is preferred over percutaneous intervention for diabetic patients with multivessel disease.
- Bilateral internal thoracic arteries (BITA) offer superior long-term graft patency but raise concerns about deep sternal wound infection (DSWI) in diabetic patients.
- Existing studies on DSWI risk with BITA in diabetics present conflicting findings, necessitating a systematic review.
Purpose of the Study:
- To systematically evaluate the incidence of deep sternal wound infection (DSWI) in diabetic patients undergoing coronary artery bypass graft (CABG) surgery using either left internal thoracic artery (LITA) or bilateral internal thoracic arteries (BITA) harvest.
- To compare the risks associated with different BITA harvest techniques (skeletonized vs. pedicled) in diabetic patients.
Main Methods:
- A comprehensive literature search was conducted across MEDLINE, EMBASE, World of Science, and the Cochrane library.
- Included studies were randomized controlled trials and observational studies comparing DSWI incidence between LITA and BITA harvest in diabetic patients.
- Random effect models were employed to calculate risk ratios for DSWI.
Main Results:
- The analysis included one RCT and ten observational studies, encompassing 126,235 diabetic patients (122,465 LITA, 3,770 BITA).
- The incidence of DSWI was 1.6% for LITA and 3.1% for BITA, with a risk ratio of 1.71 (1.37–2.14) for BITA compared to LITA.
- Skeletonized BITA harvest showed a similar DSWI risk to LITA (RR 0.9 [0.42–2.09]), whereas pedicled BITA harvest significantly increased risk (RR 1.77 [1.4–2.23]). Early mortality was comparable between groups.
Conclusions:
- Deep sternal wound infection risk in diabetic patients undergoing CABG can be mitigated by using skeletonized bilateral internal thoracic arteries (BITA) with careful preservation of sternal blood flow.
- Pedicled BITA harvest is strongly discouraged in diabetic patients due to a significantly elevated risk of postoperative deep sternal wound infection.
- Meticulous surgical technique is crucial for minimizing DSWI when employing bilateral internal thoracic arteries 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.
