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
