Document Detail


Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes.
MedLine Citation:
PMID:  14666001     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Mark D Peterson; Michael A Borger; Vivek Rao; Charles M Peniston; Christopher M Feindel
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
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:
Created Date:  2003-12-10     Completed Date:  2004-01-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1314-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, Toronto General Hospital, and Department of Surgery, University of Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
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:
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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