Bilateral mammary artery grafting increases postoperative mediastinitis without survival benefit in obese patients

Ruka, Emmeline; Dagenais, François; Mohammadi, Siamak; Chauvette, Vincent; Poirier, Paul; Voisine, Pierre

doi:10.1093/ejcts/ezw164

Cited by 34 publications

(28 citation statements)

References 24 publications

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“…The use of chlorhexidine was instructed to be performed for 5 days before surgery since chlorhexidine has the theoretical advantage of longer antimicrobial activity (>48 hours), compared with 2 hours of isopropyl alcohol alone . The prevalence of mediastinitis before implementation of the CCPPM was 1.4%, which is similar to the general incidence previously described in the literature . After the implementation of the CCPPM occurred an expressive reduction of mediastinitis to 0.09% (virtually null).…”

Section: Discussionsupporting

confidence: 64%

“…13 The prevalence of mediastinitis before implementation of the CCPPM was 1.4%, which is similar to the general incidence previously described in the literature. 14,15 After the implementation of the CCPPM occurred an expressive reduction of mediastinitis to 0.09% (virtually null). The findings of the post-CCPPM period cannot be attributed to the higher prevalence of comorbidities 16…”

Section: Discussionmentioning

confidence: 98%

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Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

et al. 2019

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Background Surgical site infections after cardiac surgery are associated with severe outcomes, including reoperation and death. We aimed to describe the effect of a standardized clinical‐care protocol for preventing mediastinitis in patients who underwent coronary artery bypass graft surgery (CABG). Methods In a hospital certified by Joint Commission International, all patients who underwent CABG from January 2011 to December 2016 were compared in two periods according to the moment of implementation of a standardized clinical‐care protocol for prevention of mediastinitis (CCPPM): pre‐protocol (January 2011‐December 2012) and post‐protocol (January 2013‐December 2016). The CCPPM consisted of the patient using a kit containing chlorhexidine 2% for bathing, mupirocin 20 mg/g for nasal topical use and chlorhexidine 0.12% for oral hygiene for 5 days before surgery, in addition to prophylaxis with a glycopeptide antimicrobial and strict glucose control (110‐140 mg/dL) during surgery and immediate postoperative. Results We evaluated 1760 patients who underwent CABG in both periods. The occurrence of mediastinitis before protocol implementation was 1.44% (10 of 692 CABG). After the implementation of the protocol, there was an important reduction in the incidence of mediastinitis to 0.09% (1 of 1068 CABG) (P = 0.002). Although we did not observe a significant difference in mortality between the groups (2.3% vs 1%, P = 0.77), there was fewer in‐hospital mortality due to mediastinitis after the CCPPM (0.2% vs 0%, P < 0.001). Conclusion Implementation of a standardized CCPPM was associated with a significant reduction in the incidence of mediastinitis after CABG and reduction of mortality in the group of patients with mediastinitis.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 98%

Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

et al. 2019

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“…In a similar retrospective study by Ruka and colleagues, 5583 obese patients were included. After propensity score matching, BITA was not associated with significantly improved long-term survival at a median follow-up of 7.4 years [42]. In a large trial of 1,526,360 patients, obesity was identified as an independent risk factor for SWI, but in the BITA group, only patients with chronic complications of diabetes had a significantly higher risk with an OR of 1.90 (95% CI 1.51-2.41) [18].…”

Section: Bita Grafting In Obese Patientsmentioning

confidence: 83%

“…In the Benedetto cohort, the frequency of deep sternal wound infection (DSWI) was 2.6% in the BITA group and 0.9% in the SITA group, but the difference did not reach statistical significance [41]. In the Ruka study, the frequency of DSWI was 3.2% in the BITA group, and 1.1 in the SITA group (P < 0.001) after matching [42].…”

Section: Bita Grafting In Obese Patientsmentioning

confidence: 99%

Bilateral versus Single Internal-Thoracic-Artery Grafts

2017

N Engl J Med

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Purpose of Review Several advances have been made in recent years to improve outcome for patients with coronary artery disease. One of the most debated topics regarding surgical treatment with coronary artery bypass grafting (CABG) is graft selection. This review aims to present the current status and scientific evidence for bilateral internal thoracic artery (BITA) grafting. Recent Findings Observational studies and pooled analyses suggest that BITA grafting is associated with improved survival. Early results from a large randomized controlled trial report safety and efficacy of the method. The improved survival might be amplified in select groups, but with an increase in sternal wound-related complications. The benefit of BITA grafts seems to remain to an approximate age of 69 years at surgery. Summary CABG with BITA grafts is likely associated with improved long-term survival at a cost of an increase in sternal wound infections. Ten-year results from the Arterial Revascularization Trial are expected in 2018, providing the best evidence regarding the method yet. Early results show it is a safe method in most patient categories considerable for CABG.

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“…However, based on the Society of Thoracic Surgeons National Database report, less than 4% of patients undergoing CABG receive BIMA grafts . The reason for reluctance to use BIMA grafts may be that there is still concern about an increased risk of sternal wound infection using BIMA, particularly in patients with diabetes mellitus, and/or obesity . We believe that avoiding sternotomy by performing robotic BH‐TECAB in obese patients is the most effective way to avoid this risk altogether while allowing the benefits of using BIMA grafts.…”

Section: Resultsmentioning

confidence: 99%

Is robotic beating heart totally endoscopic coronary artery bypass feasible for BMI > 35 morbidly obese patients?

Kuwabara

Patel

McCrorey

et al. 2018

Robotics Computer Surgery

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Bilateral mammary artery grafting increases postoperative mediastinitis without survival benefit in obese patients

Cited by 34 publications

References 24 publications

Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

Bilateral versus Single Internal-Thoracic-Artery Grafts

Is robotic beating heart totally endoscopic coronary artery bypass feasible for BMI > 35 morbidly obese patients?

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