Risk Of Sternal Wound Complications Research Articles

Bilateral Internal Thoracic Artery Grafting Current State of the Art

The purpose of this article is to review the key literature and assess the current status of bilateral internal thoracic artery grafting. Numerous retrospective studies have demonstrated a benefit of bilateral internal thoracic artery grafting over single internal thoracic artery grafting in terms of the long-term risk of all-cause death, cardiac-related death, and cardiac events. The survival benefit of bilateral internal thoracic artery grafting manifests relatively early after operation for high-risk patients. The skeletonization technique reduces the risk of sternal wound complications in all patients and particularly in those with diabetes. Both the left and right internal thoracic arteries have better patency when grated to the left coronary territory than saphenous vein. However, the right internal thoracic artery does not always have good patency when grafted to the right coronary artery. Bilateral internal thoracic artery grafting using the skeletonization technique is recommended for revascularization of the left coronary territory.

Robotic total endoscopic coronary artery bypass hybrid revascularization procedure in a patient with a preoperative tracheostoma

Preoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. Robotic totally endoscopic coronary artery bypass grafting in patients with a tracheostoma has not been reported. We describe a case of completely endoscopic coronary surgery using the daVinci(®) Si™ system in a patient with a tracheostoma. Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma.

Does Bilateral Pedicle Internal Thoracic Artery Harvest Increase the Risk of Mediastinitis?

PurposeBilateral in situ internal thoracic artery (ITA) bypassing may result in excellent myocardial revascularization without increasing the risk of deep sternal wound infection. Although there have been concerns with the use of pedicled bilateral ITA, the risk of infection may not be greater than the use of skeletonized ITA.Materials and MethodsThe present study was retrospectively undertaken to determine if pedicled BITA grafts are associated with a higher risk of sternal wound complications. A total of 207 patients who underwent bilateral ITA bypasses with or without existing diabetes mellitus, and 162 patients of those received bilateral pedicled ITA and 98 patients received unilateral ITA bypass grafts.ResultsNo sternal wound complications were noted in either the bilateral ITA or unilateral left ITA groups.ConclusionBilateral pedicled ITA harvesting was not associated with a greater incidence of infectious sternal complications compared to patients receiving unilateral ITA bypass grafts.

A novel technique of coronary revascularization in porcelain aorta: Report of two cases

Severe atherosclerosis of the distal ascending aorta increases the risk of intraoperative stroke during coronary artery bypass. More than one in situ arterial graft is required to avoid aortic manipulation during proximal anastomosis. The application of bilateral internal thoracic arteries is a good choice, but it also carries the risk of sternal wound complications. Using a composite graft constructed with a partially harvested in situ right internal thoracic artery graft and another vascular conduit prevents extreme ischemia of the sternum. This study describes the experience of successful coronary revascularization using bilateral internal thoracic arteries and modified with a composite graft in two patients with a severely atherosclerotic ascending aorta.

Invited commentary

Invited commentary

Coronary bypass by complete sternotomy in a patient with a tracheostoma

Patients with a laryngectomy pose a challenge when they require cardiac surgery. Dissection of the manubrium and sternal notch from surrounding soft tissues can be hazardous, as it may result in troublesome bleeding and inadvertent tracheal injury, especially in those patients, in whom the trachea is displaced anteriorly, or lies close to the sternal notch, as a result of a 'low' tracheal stoma. Performing a median sternotomy in such patients is believed to substantially increase the risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injuries, leading to several modifications of conventional median sternotomy, including bilateral thoracotomy incisions and limited median sternotomy approaches. There is only one case reported in the literature wherein cardiac surgery was done in such a patient, through a full sternotomy. This report describes a successful coronary artery bypass grafting through a complete median sternotomy, with no complications. This approach permitted adequate operative exposure and separated the stoma from the operative field. We also review alternative modalities of access, in these patients.

A previous mastectomy does not increase sternal complications after coronary artery bypass grafting regardless of whether an internal mammary artery is used.

A mastectomy for breast cancer may alter the selection of grafts or the postoperative outcomes after coronary artery bypass grafting (CABG). To clarify these points, a retrospective analysis of patients who underwent CABG after a mastectomy was undertaken. A total of 19 mastectomy patients (13 left, 6 right, and 1 bilateral mastectomy) were identified prior to CABG, and their perioperative data as well as late outcomes were examined. The studied group consisted of all females with a mean age of 68.8 +/- 6.2 years. The internal mammary artery (IMA) was used in 14 (73.7%) patients; however, there were no patients in whom bilateral IMAs were harvested. Among these 14 patients, an ipsilateral IMA was harvested in 6 and a contralateral IMA in 8. Alternative grafts were selected in 6 patients. A contralateral IMA or other graft conduits were utilized instead of an ipsilateral IMA. There were no in-hospital deaths or sternal wound complications. With a mean follow-up of 2.6 years, 3 patients died (1 cardiac death and 2 noncardiac deaths) and 1 patient developed angina due to de-novo coronary artery stenosis. In patients who have undergone a previous mastectomy, CABG using a single IMA is considered to be safe. If the IMA has good pulsation and if IMA harvesting is not difficult, even after a mastectomy, it can be used as a graft conduit without increasing the risk of sternal wound complications.

P10 Double internal mammary coronary artery bypass does not increase the risk for sternal wound complications: A review of 317 consecutive patients

P10 Double internal mammary coronary artery bypass does not increase the risk for sternal wound complications: A review of 317 consecutive patients