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Thorac Cardiovasc Surg 2021; 69(07): 639-648
DOI: 10.1055/s-0040-1713662
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Wound Infection after CABG Using Internal Mammary Artery Grafts: A Meta-Analysis

Irina Oswald
1   Department of Adult and Pediatric Cardiovascular Surgery, Justus Liebig University Giessen, Giessen, Germany
,
Andreas Boening
1   Department of Adult and Pediatric Cardiovascular Surgery, Justus Liebig University Giessen, Giessen, Germany
,
Joern Pons-Kuehnemann
2   Institute of Medical Informatics, Department of medical Statistics, Justus Liebig University Giessen, Giessen, Germany
,
Philippe Grieshaber
1   Department of Adult and Pediatric Cardiovascular Surgery, Justus Liebig University Giessen, Giessen, Germany
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Abstract

Background Internal mammary arteries show better long-term patency rates than venous grafts. The use of both mammary arteries is associated with a higher risk of sternal wound infections. This meta-analysis was designed to assess the incidence of a wound healing disorder after bilateral compared with single mammary artery bypass grafting. Compared with existing meta-analysis this paper includes more current literature and one randomized controlled trial.

Methods A literature search was performed using PubMed and the Cochrane Library. The quality of the articles was assessed by the Newcastle Ottawa Scale. The odds ratio was used as a measure of the chance of developing a wound healing disorder after bilateral internal mammary artery (BIMA) surgery. Meta-analyses were performed for different subgroups.

Results Twenty studies met the quality criteria, including one randomized controlled trial. The use of both mammary arteries significantly increased the risk of superficial (odds ratio [OR] 1.72) and deep (OR 1.75) wound healing disorder in the total population (OR 1.80) as well as in the diabetic subgroup (OR 1.38) and with both preparation techniques. The increased risk with BIMA grafting was present independently of the preparation technique (pedicled: OR 1.89, skeletonized: OR 1.37).

Conclusion Bilateral internal mammary artery grafting, especially in high-risk and diabetic patients, is associated with an increased risk of wound healing impairment. Skeletonized preparation does not eliminate the elevated wound healing disorder risk after BIMA use.

Keywords

internal mammary - artery bypass grafting - wound healing disorder


Publication History

Received: 22 March 2020

Accepted: 11 May 2020

Article published online:
13 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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