68. Bilateral internal mammary artery in coronary artery bypass grafting and the risk of sternal wound infection in diabetic patients

Abstract

Background Coronary artery bypass grafting is superior to percutaneous interventions in diabetic patients with multi-vessel coronary disease. The use of bilateral internal mammary arteries may lead to better long-term survival, but the risk of postoperative deep sternal wound infection has limited its use in diabetic patients. However, studies have reported conflicting results. Methods MEDLINE, EMBASE, World of Science, and the Cochrane library were searched for studies comparing the incidence of deep sternal wound infection in diabetic patients undergoing either (LITA) or BITA harvest. We used random effect models to compare risk ratios within groups. Results One randomized controlled trial and 10 observational studies (126,235 diabetic patients: 122,465 LITA, 3770 BITA) met inclusion criteria. Deep sternal wound infection occurred in 3.1% and 1.6% for the BITA and LITA cohorts, respectively. The risk ratio for deep sternal wound infection development was 1.71 (1.37–2.14) for BITA compared with LITA. Patients who underwent skeletonized BITA harvest had a similar risk of deep sternal wound infection compared with LITA (0.9 [0.42–2.09]), although pedicled harvest demonstrated increased risk (1.77 [1.4–2.23]). Early mortality was comparable in the LITA cohort (2.5%) and the BITA cohort (2.3%; p = 0.8). Conclusions The risk of sternal wound infection can be minimized in diabetic patients undergoing CABG by performing ITA harvested in a skeletonized manner with meticulous attention to preserving sternal blood flow. Pedicled harvest is to be discouraged when utilizing both ITA owing to a significant increase in the risk of sternal wound infection.