Deep Sternal Wound Infection After Beating Heart Coronary Artery Bypass Surgery with Routine Use of Skeletonized...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Infections

Background:

• Bilateral internal thoracic artery (BITA) grafting offers survival benefits but is underutilized due to deep sternal wound infection (DSWI) concerns.
• Off-pump coronary artery bypass grafting (OPCABG) is a common surgical approach for coronary artery disease.

Purpose of the Study:

• To evaluate the incidence of DSWI associated with the routine use of BITA grafting in conjunction with OPCABG.
• To identify risk factors contributing to DSWI in patients undergoing BITA and OPCABG.

Main Methods:

• A retrospective analysis of 1,207 patients undergoing isolated coronary artery bypass grafting between January 2010 and December 2020.
• All patients underwent attempted OPCABG, with BITA used for left coronary artery grafting when indicated. DSWI was defined as infection requiring surgical intervention or antibiotics.
• Multiple linear regression was used to analyze DSWI risk factors.

Main Results:

• The overall DSWI incidence was low at 0.58%.
• No significant difference in DSWI rates was found between BITA (70.6%) and single internal thoracic artery (29.4%) use (P=0.680).
• Independent risk factors for DSWI included diabetes, unstable angina, prior myocardial infarction, reduced left ventricular ejection fraction, and emergency surgery. Diabetes, hyperlipidemia, and obesity were more prevalent in the DSWI group.

Conclusions:

• Routine use of skeletonized BITA grafting following OPCABG is associated with satisfactory DSWI incidence and operative mortality.
• The study highlights the safety of BITA grafting in OPCABG when performed routinely.
• Identifying and managing risk factors like diabetes is crucial for minimizing DSWI in these patients.