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Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting
Aisha Zia1, Marium Hasan2, Sidra Ilyas3
1Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Bilateral internal thoracic artery grafting (BITA) offers survival benefits in coronary artery bypass grafting (CABG). This review details strategies to reduce deep sternal wound infections (DSWI), aiming to increase BITA adoption.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Infectious Disease Prevention
Background:
- Bilateral internal thoracic artery grafting (BITA) is associated with improved survival in coronary artery bypass grafting (CABG) patients.
- Widespread adoption of BITA is limited by concerns regarding deep sternal wound infections (DSWI).
- Recent advancements have reduced the overall incidence of DSWI in CABG procedures.
Purpose of the Study:
- To identify and describe strategies for preventing DSWI in patients undergoing CABG with BITA.
- To encourage the increased implementation of DSWI preventive measures.
- To facilitate greater utilization of the BITA technique by mitigating associated risks.
Main Methods:
- Comprehensive literature review to identify DSWI preventive strategies.
- Detailed description of identified preventive measures.
- Analysis of strategies aimed at reducing DSWI risk in BITA grafting.
Main Results:
- Identified key strategies for DSWI prevention in CABG surgery.
- Provided detailed information on the application of these preventive measures.
- Highlighted the decreasing trend of DSWI in recent years due to implemented strategies.
Conclusions:
- Implementing DSWI preventive strategies can significantly minimize infection risk after BITA grafting.
- Increased adoption of these strategies can lead to wider utilization of the effective BITA technique.
- This review aims to bridge the gap between BITA's survival benefits and its clinical application by addressing infection concerns.
Abstract:
Although the survival advantage of bilateral internal thoracic artery grafting (BITA) is well known in patients undergoing coronary artery bypass grafting (CABG), this technique has not been widely adopted. This is mainly because of the increased risk of deep sternal wound infections (DSWI) associated with its use. However, in recent years the overall risk of DSWI has decreased. This is mainly because of strategies that have been adopted to decrease the risk of these infections in patients undergoing CABG. In this review we identified DSWI preventive strategies and described them in detail so that their use by surgeons can be increased. This would minimize the risk of DSWI after BITA grafting and maximize the use of this highly effective surgical technique.
