Abstract
Purpose: We harvested bilateral Internal Mammary Arteries and made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective of the presence or absence of various risk factors for sternal dehiscence. The purpose of this study was to find an effective way of sternal closure in patients undergoing OPCAB with both the Internal Mammary Arteries harvested for grafting. Method: The patients who did not have any risk factors were placed in group I and all of them had a standard six wire closure of sternotomy. The patients having any risk factors were placed in group II. The patients in group II were randomized by including every alternate patient from group II to subgroup II A and every other alternate patient from group II to subgroup II B. Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy. Results: The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure then the rate of sternal complications in the patients with risk factors for sternal dehiscence was not more than the patients without risk factors. Conclusion: We can harvest bilateral Internal Mammary Arteries for OPCAB without fear of sternal complications even in patients with high risk for sternal dehiscence if we use bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure.
Highlights
Sternal dehiscence after median sternotomy is a serious complication and may lead to prolonged hospitalization, increased cost of care and significant mortality [1] [2] [3] [4]
Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy
The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB
Summary
Sternal dehiscence after median sternotomy is a serious complication and may lead to prolonged hospitalization, increased cost of care and significant mortality [1] [2] [3] [4]. It has been said that rate of these complications is higher if bilateral Internal Mammary Arteries (IMAs) have been harvested in a case of coronary artery bypass grafting This risk is even higher if the IMAs have been harvested with pedicle because it compromises the blood supply to sternum, whereas if the skeletonized IMAs have been used it preserves the blood supply to sternum and risk of sternal complications is less. These complications include sternal instability, dehiscence and mediastinitis as a result of bone non-consolidation or bone disruption caused by steel wires. These conditions are major cause of morbidity and mortality after cardiac surgery [6]
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