Sternal wound infections following internal mammary artery grafts for a coronary bypass: A meta-analysis

Mingmei Li1, Zhenxing Yu2, Qiong Chen3

  • 1Department of Nephrology, Erqiao Street Community Health Service Cente affiliated of the Fifth Hospital of Wuhan, Wuhan, China.

PubMed

Insights

Bilateral internal mammary artery grafts increase sternal wound infection risk after coronary bypass surgery. This risk is higher in diabetics, the elderly, and with specific graft preparations.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Disease Epidemiology

Background:

  • Sternal wound infections (SWIs) are a serious complication following coronary artery bypass grafting (CABG).
  • The choice between single internal mammary artery (SIMA) and bilateral internal mammary artery (BIMA) grafting is debated regarding SWI risk.

Approach:

  • A meta-analysis was conducted on 31 studies (2001-2023) involving 181,503 patients undergoing CABG.
  • Dichotomous random- or fixed-effect models were used to compute Odds Ratios (OR) and 95% Confidence Intervals (CIs) for SWI.
  • Studies comparing BIMA to SIMA were included, irrespective of language.

Key Points:

  • BIMA grafting was associated with a significantly higher risk of overall SWI (OR, 1.51; 95% CI, 1.37-1.68).
  • Increased risks were observed for superficial SWI (OR, 1.72), deep SWI (OR, 1.62), SWI in diabetics (OR, 1.48), and the elderly (OR, 1.38).
  • Higher SWI rates were also noted for pedicled (OR, 1.70) and skeletonized (OR, 1.40) BIMA preparations compared to SIMA.

Conclusions:

  • Bilateral internal mammary artery grafting is linked to a significantly increased risk of sternal wound infections post-CABG.
  • This elevated risk is particularly pronounced in specific patient populations (diabetics, elderly) and with certain surgical techniques (pedicled, skeletonized).
  • Surgeons should exercise caution when considering BIMA, acknowledging potential wound healing complications and variability in surgical expertise.