Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting

Abstract

Background: Although the survival advantage of bilateral internal thoracic artery grafting (BITA) is well known in patients undergoing coronary artery bypass grafting (CABG), this technique has not been widely adopted. This is mainly because of the increased risk of deep sternal wound infections (DSWI) associated with its use. However, in recent years the overall risk of DSWI has decreased. This is mainly because of strategies that have been adopted to decrease the risk of these infections in patients undergoing CABG. Conclusion: In this review we identified DSWI preventive strategies and described them in detail so that their use by surgeons can be increased. This would minimize the risk of DSWI after BITA grafting and maximize the use of this highly effective surgical technique.

Commentary: Sternotomy closure in high‐risk patients: Is longitudinal rigid sternal fixation the optimal approach?

“…Given that the use of bilateral internal mammary artery (BIMA) in CABG operations in high-risk patients has been shown to be associated with a higher rate of sternal complications, differences in the proportion of patients who underwent CABG with BIMA between the compared groups may confound these outcomes. [11][12][13] In addition, surgeon volume differed between the LRSF and CWC groups. A single surgeon conducted all operations in the LRSF group compared to multiple surgeons in the CWC group, which may introduce a confounding variable related to the operative approach in the CWC group.…”

“…Vessels used in coronary artery bypass grafting (CABG) operations were not reported. Given that the use of bilateral internal mammary artery (BIMA) in CABG operations in high‐risk patients has been shown to be associated with a higher rate of sternal complications, differences in the proportion of patients who underwent CABG with BIMA between the compared groups may confound these outcomes 11–13 . In addition, surgeon volume differed between the LRSF and CWC groups.…”