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wound infection in bilateral mammary diabetic patients

Yasser Y Hegazy, Wael Hassanein, Jürgen Ennker, Noha Keshk, Stefan Bauer, Ralf Sodian
Background Obesity is a limiting factor for the use of bilateral internal mammary arteries (BIMAs). Therefore, we assessed the safety of their use in different degrees of obesity. Patients and Methods We studied two groups of patients with obesity using propensity matching. The first group received single internal mammary artery and saphenous vein grafts (SIMA group, 526 patients) and the second group received bilateral internal mammary arteries (BIMA group, 526 patients). Patients were classified further according to their body mass index (BMI) into overweight (BMI = 25-29...
June 2017: Thoracic and Cardiovascular Surgeon
Josías Caleb Ríos Ortega, Paul Castañeda Castillo, Luisa Talledo Paredes, Franz Soplopuco Palacios, Necemio Aranda Pretell, Yemmy Pérez Valverde, Julio Morón Castro, Andrés Reyes Torres
INTRODUCTION: Coronary artery bypass graft (CABG) surgery remains the reference standard in the treatment of multivessel coronary disease. Several studies have shown that CABG with bilateral internal mammary arteries (BIMA) has better results in long-term survival. METHODOLOGY: A retrospective study was conducted on CABG surgeries with BIMA from January 2012 to December 2015 in the National Cardiovascular Institute, INCOR, EsSalud, Peru. The objectives were to determine the mortality and major cardiovascular events at 30 days follow-up...
January 5, 2017: Archivos de Cardiología de México
Giuseppe Gatti, Andrea Perrotti, Daniel Reichart, Luca Maschietto, Francesco Onorati, Sidney Chocron, Magnus Dalén, Peter Svenarud, Giuseppe Faggian, Giuseppe Santarpino, Theodor Fischlein, Aniello Pappalardo, Daniele Maselli, Carmelo Dominici, Saverio Nardella, Antonino S Rubino, Marisa De Feo, Francesco Santini, Francesco Nicolini, Riccardo Gherli, Giovanni Mariscalco, Tuomas Tauriainen, Eeva-Maija Kinnunen, Vito G Ruggieri, Matteo Saccocci, Fausto Biancari
BACKGROUND: Glycated hemoglobin (HbA1c) is a suspected risk factor for sternal wound infection (SWI) after CABG.Methods and Results:Data on preoperative HbA1c and SWI were available in 2,130 patients undergoing isolated CABG from the prospective E-CABG registry. SWI occurred in 114 (5.4%). Baseline HbA1c was significantly higher in patients with SWI (mean, 54±17 vs. 45±13 mmol/mol, P<0.0001). This difference was also observed in patients without a diagnosis of diabetes (P=0.027), in insulin-dependent diabetic (P=0...
December 22, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Yasser Yehia Hegazy, Ralf Sodian, Wael Hassanein, Amr Rayan, Juergen Ennker
BACKGROUND: The use of bilateral internal mammary arteries (BIMA) is limited worldwide, especially in patients with chronic obstructive pulmonary disease (COPD). Thus, we assessed the safety of the use of BIMA in COPD patients. METHODS: From cohorts of 8846 patients operated on at our center for primary isolated multi-vessel coronary bypass operations between 2002 and 2012, we studied two propensity-matched groups of patients with COPD who received either single internal mammary artery and saphenous vein grafts (SIMA group: 137 patients) or exclusively BIMA (BIMA group: 137 patients)...
October 31, 2016: Heart Surgery Forum
Kristina Lenz, Michael Brandt, Sandra Fraund-Cremer, Jochen Cremer
The incidence of sternal wound infections (SWI) after coronary artery bypass surgery (CABG) as reported worldwide is low. However, it is associated with significant increase of postoperative mortality and treatment costs. The major risk factors discussed are diabetes mellitus and bilateral IMA harvesting of the internal mammary artery. This study analyses data of 590 patients receiving CABG concerning the risk factors for SWI. Sternal wound infections occur significantly more often in diabetic patients, one crucial and significant additional risk factor is obesity...
2016: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
(no author information available yet)
UNLABELLED: The above Accepted Article, published online on 29 June 2015 in Wiley Online Library (, has been retracted by agreement between the authors, the journal Editors in Chief, Professor Zachary T. Bloomgarden and Professor Guang Ning, and Wiley Publishing Asia Pty Ltd. The article incorrectly listed Guang Ning and Qiang Zhao as co-authors, but neither of them actually were involved in the study, or in the writing of the manuscript. Both were included as coauthors without permission...
January 2016: Journal of Diabetes
Shinji Ogawa, Yasuhide Okawa, Koshi Sawada, Yoshihiro Goto, Masanori Yamamoto, Yutaka Koyama, Hiroshi Baba, Takahiko Suzuki
OBJECTIVES: Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA. METHODS: The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed...
February 2016: European Journal of Cardio-thoracic Surgery
Kan Kajimoto, Taira Yamamoto, Atsushi Amano
This study examined the effect of coronary artery bypass graft surgery with bilateral internal thoracic artery grafting in diabetic patients. Coronary artery bypass graft surgery using skeletonized bilateral internal thoracic artery grafts was not associated with an increased risk of deep sternal wound infection or early death. Moreover, patients who underwent coronary artery bypass graft surgery using bilateral internal thoracic artery grafting had lower remote mortality and cardiac mortality. We conclude that coronary artery bypass surgery using bilateral internal thoracic artery grafts is an excellent strategy, even for diabetic patients...
March 2015: Annals of Thoracic Surgery
Shahzad G Raja
Coronary artery disease (CAD) is a leading cause of mortality and morbidity in diabetics. Diabetics make up to 20%-35% of all patients undergoing coronary revascularization. Patients with diabetes represent a particularly difficult subset for revascularization due to increased short- and long-term mortality as well as a higher risk of repeat revascularization procedures. Potential factors contributing to the increased risk include co-morbid illnesses, small, diffusely diseased target vessels, progression of native CAD, hyperglycaemic endothelial dysfunction, and systemic inflammation...
April 2015: International Journal of Surgery
Michel Pompeu Barros Oliveira Sá, Paulo Ernando Ferraz Cavalcanti, Henrique José de Andrade Costa Santos, Artur Freire Soares, Rodrigo Gusmão Albuquerque Miranda, Mayara Lopes Araújo, Ricardo Carvalho Lima
BACKGROUND: It is suggested that the internal thoracic artery (ITA) harvesting technique influences the incidence of sternal wound infection (SWI) after coronary artery bypass graft (CABG) surgery when both right and left ITAs are used. We conducted a meta-analysis to determine whether there is any difference between skeletonized versus pedicled bilateral ITA in terms of SWI after CABG. METHODS: We performed a systematic-review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that compared the incidence of SWI after CABG between skeletonized versus pedicled bilateral ITA until May 2014...
April 2015: International Journal of Surgery
Faizan Imran Bawany, Muhammad Shahzeb Khan, Asadullah Khan, Abdul Nafey Kazi, Muhammed Naeem
Coronary artery bypass graft surgery relieves angina symptoms and reduces mortality among ischaemic heart disease patients. It remains the gold standard for the treatment of multi-vessel and left main coronary artery disease. It is a well-known fact that internal mammary artery conduits have excellent and long-lasting patency when used for coronary artery bypass grafting. Its supremacy is largely because it prevents atherosclerosis. The old-style internal mammary artery bypass grafting, classically known as pedicle grafting, includes a circular rim of tissue around the graft...
May 2014: JPMA. the Journal of the Pakistan Medical Association
Shahzad G Raja, Umberto Benedetto, Anand Jothidasan, Raju Krishnam Jujjavarapu, Uchenna Franklin Ukwu, Fabio De Robertis, Toufan Bahrami, Jullien A Gaer, Mohamed Amrani
OBJECTIVE: Additional arterial grafts such as the right internal mammary artery (RIMA) or the radial artery (RA) have been proposed to improve long term outcomes in coronary artery bypass grafting (CABG). RA is largely preferred over RIMA as it is less technically demanding and there is a perception that bilateral IMA usage increases the risk of sternal wound complications. However, there is a paucity of direct comparison of the two conduits to guide surgeons to choose the best second arterial conduit for CABG...
April 2015: International Journal of Surgery
Teresa M Kieser, M Sarah Rose, Uthman Aluthman, Marlene Montgomery, Thomas Louie, Israel Belenkie
OBJECTIVE: Coronary artery bypass graft (CABG) surgery with arterial conduits is considered optimal. A deterrent to bilateral internal thoracic artery (BITA) grafting is the risk of deep sternal wound infection (DSWI). We introduced infection prevention measures sequentially, attempting to reduce DSWIs. The aim was to determine (1) if the absence of DSWIs in the last 469 of 1001 consecutive operations was significant; (2) which measures explained the change; and (3) the impact of diabetes...
November 2014: Journal of Thoracic and Cardiovascular Surgery
Oren Lev-Ran, Menachem Matsa, Yaron Ishay, Moataz Abo Abod, Alina Vodonos, Gideon Sahar
BACKGROUND: We sought to assess the risk and late outcome of bilateral internal thoracic artery grafting in eligible insulin-treated diabetic subsets. METHODS: 147 insulin-treated diabetic patients undergoing arterial revascularization were grouped as: skeletonized bilateral internal thoracic artery (n = 83) or internal thoracic artery-radial artery (n = 64). Chronic lung disease or overweight and female constituted exclusion criteria for bilateral internal thoracic artery grafts...
December 2013: Asian Cardiovascular & Thoracic Annals
Siamak Mohammadi, Dimitri Kalavrouziotis, Giovanni Cresce, François Dagenais, Eric Dumont, Eric Charbonneau, Pierre Voisine
OBJECTIVES: The use of bilateral internal thoracic arteries (BITA) has been associated with improved long-term outcomes following coronary artery bypass graft (CABG) surgery. The objective of this study was to evaluate the impact of BITA use on long-term survival among patients with low ejection fraction (EF) undergoing CABG. METHODS: Between April 1991 and October 2011, 2035 consecutive patients underwent primary BITA grafting. Among them, there were 129 patients with left ventricular EF ≤40%...
September 2014: European Journal of Cardio-thoracic Surgery
James Tatoulis
Arterial coronary grafts can be used in the majority of patients and have better patencies than saphenous vein grafts (SVGs), resulting in excellent perioperative and superior long-term outcomes. Barriers to their extensive use include potential for trauma and spasm, extra-operating time, unfamiliarity, concerns over hypoperfusion and deep sternal wound infection in patients in whom bilateral internal thoracic arteries are used-especially diabetics. This presentation addresses these concerns with particular attention to the radial artery, and skeletonized right internal thoracic artery harvest and construction of the proximal anastomoses of these grafts to the ascending thoracic aorta...
2013: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Hashim Muhammad Hanif, Zeb Ijaz Saeed, Adil Sheikh, Syed Shahabuddin, Hasanat Sharif
OBJECTIVES: To analyze our experience of conducting Bilateral Internal Mammary Artery (BIMA) grafting, using both pedicled and free grafts for coronary revascularization, assessing the safety and efficacy of the procedure and comparing any differences observed between the two techniques of harvesting the grafts. METHODS: A retrospective cross sectional study was conducted in July 2010 in which all 48 patients undergoing bilateral internal mammary artery grafting for coronary bypass surgery at the Aga Khan University Hospital from 1996 to 2010 were reviewed and evaluated...
July 2012: JPMA. the Journal of the Pakistan Medical Association
Adel Sakic, Orest Chevtchik, Juliane Kilo, Roland Schistek, Ludwig C Mueller, Hanno Ulmer, Michael Grimm, Elfriede Ruttmann
OBJECTIVES: Limited blood supply to the thoracic chest wall is a known risk factor for sternal wound complications after CABG. Therefore, bilateral internal thoracic arteries are still rarely utilized despite their proven superior graft patency. The aim of our study was to analyse whether modification of the surgical technique is able to limit the risk of sternal wound complications in patients receiving bilateral internal thoracic artery grafting. METHODS: All 418 non-emergent CABG patients receiving bilateral internal thoracic artery CABG procedures (BITA) from January 2001 to January 2012 were analysed for sternal wound complications...
August 2013: Interactive Cardiovascular and Thoracic Surgery
Shinobu Itagaki, Paul Cavallaro, David H Adams, Joanna Chikwe
OBJECTIVES: The objective of this study was to investigate the impact of bilateral internal mammary artery (BIMA) on early outcomes after coronary artery bypass grafting. DESIGN: Retrospective database analysis. SETTING: US hospitals. PATIENTS: 1 526 360 patients (mean age 65 years, 73% male) from the Nationwide Inpatient Sample from 2002-2008 who underwent isolated coronary artery bypass grafting with at least one internal mammary artery...
June 2013: Heart: Official Journal of the British Cardiac Society
Chenyang Dai, Zhexin Lu, Hongsheng Zhu, Song Xue, Feng Lian
BACKGROUND: The advantageous survival outcome of bilateral internal mammary artery grafting (BIMA) has been well established. However, this meta-analysis aims to make clear whether BIMA grafting increases the risk of sternal wound infection (SWI) when compared with single internal mammary artery grafting (SIMA). METHODS: A literature search was performed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The observational studies reporting a comparison between SIMA and BIMA were included...
June 2013: Annals of Thoracic Surgery
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