wound infection in bilateral mammary diabetic patients

BACKGROUND: Deep sternal wound infection (DSWI) remains a serious complication after coronary artery bypass grafting (CABG). We herein aimed to stratify diabetic patients who underwent CABG using bilateral internal mammary artery (BIMA) for levels of glycated hemoglobin A1C (HbA1c) and compare postoperative outcomes. METHODS: Between January 2010 and August 2020, 4,186 consecutive patients underwent isolated CABG at our center. In 3,229 patients, preoperative HbA1c levels were available...

Objectives: Analyses of incidence and time required to heal sternal wound infections after heart surgery performed via a median sternotomy between 2020 and 2022. Results: Superficial wound infections (SWI) were five times more common (2.7%) than mediastinitis (0.5%) among 2693 patients. The median time between the operation and diagnosis of SWI was 26 (interquartile range [IQR] 15-33) days vs. 16 (IQR 9-25) days for mediastinitis ( p  = .12). Gram-negative bacteria caused 44% of the 85 infections...

BACKGROUND: Deep sternal wound infection (DSWI) following open heart surgery is associated with excessive morbidity and mortality. Contemporary DSWI risk prediction models aim at identifying high-risk patients with varying complexity and performance characteristics. We aimed to optimize the DSWI risk factor set and to identify additional risk factors for early postoperative detection of patients prone to DSWI. METHODS: Single-centre retrospective analysis of patients with isolated multivessel coronary artery disease undergoing myocardial revascularization at Paracelsus Medical University Nuremberg between 2007 and 2022 was performed to identify risk factors for DSWI...

OBJECTIVES: Data on bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) on diabetics were analyzed; This is the only meta-analysis, the last 7 years. METHODS: Medline through PubMed/EMBASE/CINHAL and the Cochrane Central Register of Controlled Trials; 179 articles were studied; 19 studies deemed suitable and were included in the analysis. RESULTS: The mortality was 2.41% for BIMA versus 1.71% for SIMA (odds ratio [OR] =  0...

INTRODUCTION: Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up...

BACKGROUND: Total arterial revascularization is the most durable and technically the most demanding type of coronary artery bypass grafting procedure. It has proven long-term supremacy in comparison to conventional coronary artery bypass grafting. In our study, we investigated the reliability of EuroSCORE II as a predictor of intrahospital death. We showed its impact on adverse perioperative events. METHODS: In this nonrandomized prospective study, we analyzed 116 consecutive patients who underwent the total arterial revascularization procedure at our Institute from January 2011 until the present...

Introduction The use of more than one arterial conduit in coronary surgery has been widely associated with better long-term results. Objectives We sought to investigate the benefits of Multiple Arterial Grafts (MAG) over Single Arterial Grafts (SAG), among diabetic patients, in short and long-term results throughout a meta-analysis of propensity score matching (PSM) studies. Materials and Methods MEDLINE and ISI Web of Science were used to find relevant literature (1960-2018). We included cohort studies with at least 200 patients and that reported one of these outcomes: long-term survival, early mortality or sternal wound infection (SWI)...

This study compares the morbidity and mortality at 30 days following the use of bilateral internal mammary arteries (BIMA) vs a single internal mammary artery (SIMA) at the time of coronary artery bypass grafting (CABG) in patients with a preoperative HbA1c. Patients undergoing CABG from January 2008 to December 2016 reported to the Society of Thoracic Surgeons database were retrospectively reviewed. The patients were divided into 2 groups: use of BIMA or use of SIMA and propensity matched. To assess the effect of preoperative HbA1c, both groups were further divided into 5 subgroups: patients without diabetes mellitus (DM), or patients with DM and a preoperative HbA1c level in one of four groups (< 7%, 7-9%, 9-11%, or >11%)...

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...

This single-center study aimed to evaluate the incidence of deep sternal wound infection (DSWI) following skeletonized bilateral internal mammary artery (BIMA) harvest in a Chinese cohort. Using propensity score matching, this study also provided a present-day assessment of the impacts of skeletonized BIMA grafting versus skeletonized single internal mammary artery (SIMA) grafting on early outcomes.From January 2014 to December 2017, 2403 eligible patients were entered into either a BIMA group (n = 368) or a SIMA group (n = 2035)...

BACKGROUND: This analysis compared short-term mortality, sternal wound infection (SWI), and long-term survival outcomes in diabetic patients who underwent coronary artery bypass grafting (CABG) with bilateral (BIMA) vs. single (SIMA) internal mammary artery, as well as in diabetic vs. non-diabetic patients undergoing BIMA grafting.Methods and Results:Nineteen studies were included in the study, covering 21,143 different patients. Of these patients, 6,464 underwent CABG with BIMA, 10,264 underwent CAGB with SIMA, 11,584 had diabetes, and 6,717 did not...

OBJECTIVE: To develop a risk score for deep sternal wound infection (DSWI) after isolated coronary artery bypass grafting (CABG). DESIGN: Multicenter, prospective study. SETTING: Tertiary-care referral hospitals. PARTICIPANTS: The study included 7,352 patients from the European multicenter coronary artery bypass grafting (E-CABG) registry. INTERVENTION: Isolated CABG. METHODS: An additive risk score (the E-CABG DSWI score) was estimated from the derivation data set (66...

OBJECTIVE: Median sternotomy remains the most common access to perform cardiac surgery procedures. However, the experience of the operating surgeon remains a crucial factor during sternal closure to avoid potential complications related to poor sternal healing, such as mediastinitis. Considering the lack of major randomized controlled trials and the heterogeneity of the current literature, this narrative review aims to summarize the different techniques and approaches to sternal closure with the aim to investigate their reflections into clinical outcomes and to inform the choice on the most effective closure method after median sternotomy...

BACKGROUND AND AIM OF THE STUDY: We explored the current evidence available on total arterial revascularization (TAR) carrying out a meta-analysis of propensity score-matched studies comparing TAR versus non-TAR strategy. METHODS: PubMed, EMBASE, and Google Scholar were searched for propensity score-matched studies comparing TAR vs non-TAR. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The Der-Simonian and Laird method were used to compute the combined risk ratio (RR) of 30-day mortality, deep sternal wound infection, and reoperation for bleeding...

OBJECTIVES: Total arterial myocardial revascularization using bilateral internal mammary arteries shows improved results for mortality, long-term survival and superior graft patency. It has become the standard technique according to recent guidelines. However, these patients may have an increased risk of developing sternal wound infections, especially obese patients or those with diabetes. One reason for the wound complications may be early sternum instability. This situation could be avoided by using a thorax support vest (e...

BACKGROUND: Coronary artery bypass grafting is the first-line therapy for severe multivessel coronary artery disease. We aimed to investigate the clinical outcome in patients undergoing isolated off-pump surgery with the single or bilateral internal mammary artery (SIMA or BIMA) approach. METHODS: We performed a propensity score-matched analysis in 1,852 consecutive patients, aged 50 to 70 years, who underwent myocardial revascularization at our institution between July 2009 and August 2016...

Background: Bilateral internal mammary arteries (BIMAs) remain underused in coronary artery bypass grafting (CABG), especially in elderly, diabetic, and obese patients. This study investigated incidence of sternal wound infection (SWI), sternal instability (SI), and reintervention for bleeding (RIB) in this high-risk population. Methods: A single-center retrospective observational study was performed in "Grand Hôpital de Charleroi, Gilly, Belgium." A total of 319 patients undergoing CABG from December 2011 to December 2015 were included...

BACKGROUND: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only. METHODS: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables...

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...

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...