Effect of skeletonisation and pedicled bilateral internal mammary artery grafting in coronary artery bypass surgery on post‐operative wound infection: A meta‐analysis

Abstract

The results showed that different internal thoracic artery (ITA) was associated with the rate of postoperative wound infection and the severity of pain following coronary artery bypass grafting (CABG). In order to ascertain if there was any genuine difference in the rate of postoperative infection and severity of the pain, we conducted a meta‐analysis to evaluate if there was any actual difference in the wound complication that had been identified with the ITA method. Through EMBASE, Cochrane Library and Pubmed, and so forth, we systematically reviewed the results by August 2023, which compared the impact of skeletonised versus pedicled internal mammary artery (IMA) on wound complications following CABG. The trial data have been pooled and analysed in order to determine if a randomisation or fixed‐effect model should be applied. The meta‐analysis of data was performed with Revman 5.3 software. The results of this meta‐study included 252 related articles from four main databases, and nine articles were chosen to be extracted and analysed. A total of 3320 patients were treated with coronary artery transplantation. Based on current data analysis, we have shown that the rate of postoperative wound infections is reduced by the use of the skeletonised internal mammary artery (SIMA) (OR, 1.84; 95% CI, 1.13, 3.01; p = 0.01). But the results showed that there were no statistically significant differences in the post‐operation pain score of the patients (MD, 0.09; 95% CI, −0.58, 0.76; p = 0.79). Furthermore, the duration of the operation was not significantly different between the SIMA and pedicled internal mammary artery (PIMA) (MD, 3.30; 95% CI, −3.13, 9.73; p = 0.31). Overall, the SIMA decreased the rate of postoperative wound infection in CABG patients than the PIMA.

The Burden of Obesity in Cardiac Surgery: A 14 years’ Follow-Up of 14.754 Patients

“…Minimally invasive techniques that do not require conventional sternotomy seem to be the most promising options in cardiac surgery in obese patients: In mitral valve surgery, lateral mini thoracotomy becomes more and more common[ 28 ], and catheter techniques [ 29 ] or robotic surgery are emerging [ 30 ]. In aortic valve disease, the ongoing discussion about the indications between transcatheter aortic valve implantations and conventional approaches via sternotomy [ 31 ] should be[ 32 ] extended[ 33 ] and obese[ 34 ] patients should be treated.…”