| Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. | |
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MedLine Citation:
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PMID: 14666001 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Deep sternal wound infection is a dreaded complication of coronary artery bypass surgery, particularly in patients with diabetes. This study determines whether skeletonization of internal thoracic artery conduits compared with pedicled harvesting reduces the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting. METHODS: We reviewed prospectively gathered data on all patients who have undergone coronary artery bypass grafting and received bilateral internal thoracic artery grafts at our institution since 1990. We compared patients with diabetes who received skeletonized (n = 79) versus conventional pedicled (n = 36) internal thoracic artery conduits. RESULTS: The proportion of patients taking insulin (19.0% vs 14.0% for skeletonized vs conventional grafts, respectively, P =.6) or oral hypoglycemic agents (68.4% vs 69.4%, P =.9), as well as the prevalence of type I diabetes (2.5% vs 8.3%, P =.18), were similar in both groups. Patients who received skeletonized grafts were more likely to receive a free rather than an in situ right internal thoracic artery graft (93.7% vs 30.6%, P <.001). The prevalence of deep sternal wound infection was significantly lower in patients who received skeletonized grafts compared with patients who received conventional grafts (1.3% vs 11.1%, P =.03). Patients in the skeletonized group were also less likely to develop any (superficial or deep) sternal wound infection postoperatively (5.1% vs 22.2%, P =.03). There was no significant difference in the prevalence of deep sternal wound infection between patients with diabetes who received skeletonized internal thoracic arteries and patients without diabetes who underwent conventional internal thoracic artery grafting (n = 578) (1.2% vs 1.6%, respectively, P =.8). CONCLUSIONS: Skeletonization of internal thoracic artery conduits lowers the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting. We no longer consider diabetes a contraindication to bilateral internal thoracic artery grafting, provided the internal thoracic arteries are skeletonized. |
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Authors:
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Mark D Peterson; Michael A Borger; Vivek Rao; Charles M Peniston; Christopher M Feindel |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 126 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-12-10 Completed Date: 2004-01-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1314-9 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiac Surgery, Toronto General Hospital, and Department of Surgery, University of Toronto, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cohort Studies Coronary Artery Bypass / adverse effects, methods* Coronary Artery Disease / complications, radiography, surgery* Diabetes Mellitus, Type 1 / complications, diagnosis Diabetes Mellitus, Type 2 / complications, diagnosis Female Follow-Up Studies Graft Survival Humans Internal Mammary-Coronary Artery Anastomosis Logistic Models Male Mammary Arteries / transplantation* Middle Aged Prevalence Prospective Studies Risk Assessment Severity of Illness Index Sternum / physiopathology Surgical Wound Infection / diagnosis*, epidemiology* Thoracotomy / adverse effects, methods Tissue and Organ Harvesting Treatment Outcome Vascular Patency |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2004 Jun;127(6):1856-7; author reply 1857
[PMID:
15173765
]
J Thorac Cardiovasc Surg. 2004 May;127(5):1534-5; author reply 1535 [PMID: 15116026 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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