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Updated: Aug 1, 2026

Human Internal Mammary Artery IMA Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
Published on: May 9, 2012
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.
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.
Abstract:
The meta-analysis aims to evaluate and compare the sternal wound infections following internal mammary artery grafts for a coronary bypass. Examinations comparing bilateral internal mammary artery to single internal mammary artery for coronary artery bypass grafting were among the meta-analyses from various languages that met the inclusion criteria. Using dichotomous random- or fixed-effect models, the results of these investigations were examined, and the Odd Ratio (OR) with 95% confidence intervals (CIs) was computed. A total of 31 examinations from 2001 to 2023 were recruited for the current analysis including 181 503 personals with coronary artery bypass grafting. Bilateral internal mammary artery had significantly higher sternal wound infection (OR, 1.51; 95% CI, 1.37-1.68, p < 0.001), superficial sternal wound infection (OR, 1.72; 95% CI, 1.16-2.56, p = 0.007), deep sternal wound infection (OR, 1.62; 95% CI, 1.41-1.86, p < 0.001), sternal wound infection in diabetics (OR, 1.48; 95% CI, 1.16-1.90, p = 0.002), sternal wound infection in elderly (OR, 1.38; 95% CI, 1.22-1.57, p < 0.001), sternal wound infection in pedicled preparation (OR, 1.70; 95% CI, 1.30-2.23, p < 0.001) and sternal wound infection in skeletonized preparation (OR, 1.40; 95% CI, 1.09-1.81, p = 0.009) compared to single internal mammary artery in personals with coronary artery bypass grafting. Bilateral internal mammary artery grafting is linked to a higher risk of impaired wound healing, particularly in diabetic individuals, elderly, pedicled preparation, and skeletonized preparation. Nevertheless, caution should be exercised while interacting with its values since examinations were performed by different surgeons with different skills on different types of personals.
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