Suguru Ohira1, Hiroaki Miyata2, Sachiko Yamazaki3, Satoshi Numata3, Noboru Motomura2, Shinichi Takamoto2, Hitoshi Yaku3. 1. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: s-ohira@koto.kpu-m.ac.jp. 2. Japan Cardiovascular Surgery Database Organization, Tokyo, Japan. 3. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Abstract
OBJECTIVES: Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). The present study investigated the early outcome of BITA grafting and analyzed the risk of DSWI using a Japanese national database (the Japan Adult Cardiovascular Surgery Database). METHODS: Data from 560 hospitals were used. Between April 2012 and December 2015, BITA was harvested in 14,249 patients, corresponding to 32.6% of isolated coronary artery bypass cases. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple logistic regression analysis was employed to model the risk of DSWI. RESULTS: The mean age was 67.1 years. The prevalence of diabetes, renal failure, hemodialysis, and liver dysfunction was 51.8%, 21.2%, 7.8%, and 1.2%, respectively. The incidence of DSWI and operative mortality was 1.6 (234 patients) and 1.6% (226 patients), respectively. The operative mortality rate in patients with DSWI was 13.7% (32 patients). The off-pump technique was used in 72.8%, with a conversion rate of 2.5%. Female sex, diabetes mellitus, chronic lung disease, renal failure, liver dysfunction, ejection fraction ≤60%, shock status, reoperation, preoperative intra-aortic balloon pump use, and an increased operative time were independent risk factors for DSWI after BITA grafting. The off-pump technique did not reduce the risk of DSWI. CONCLUSIONS: The present study showed that early outcomes of BITA grafting were satisfactory regarding DSWI and operative mortality. The current data are informative to predict the risk of DSWI when performing BITA grafting.
OBJECTIVES: Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). The present study investigated the early outcome of BITA grafting and analyzed the risk of DSWI using a Japanese national database (the Japan Adult Cardiovascular Surgery Database). METHODS: Data from 560 hospitals were used. Between April 2012 and December 2015, BITA was harvested in 14,249 patients, corresponding to 32.6% of isolated coronary artery bypass cases. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple logistic regression analysis was employed to model the risk of DSWI. RESULTS: The mean age was 67.1 years. The prevalence of diabetes, renal failure, hemodialysis, and liver dysfunction was 51.8%, 21.2%, 7.8%, and 1.2%, respectively. The incidence of DSWI and operative mortality was 1.6 (234 patients) and 1.6% (226 patients), respectively. The operative mortality rate in patients with DSWI was 13.7% (32 patients). The off-pump technique was used in 72.8%, with a conversion rate of 2.5%. Female sex, diabetes mellitus, chronic lung disease, renal failure, liver dysfunction, ejection fraction ≤60%, shock status, reoperation, preoperative intra-aortic balloon pump use, and an increased operative time were independent risk factors for DSWI after BITA grafting. The off-pump technique did not reduce the risk of DSWI. CONCLUSIONS: The present study showed that early outcomes of BITA grafting were satisfactory regarding DSWI and operative mortality. The current data are informative to predict the risk of DSWI when performing BITA grafting.
Authors: Soslan Enginoev; Arian Arjomandi Rad; Sergey Ekimov; Dmitry Kondrat'ev; Gasan Magomedov; Alan Amirhanov; Bashir Tsaroev; Alexander Ziankou; Anna Motreva; Igor Chernov; Dmitry Tarasov; Bakytbek Kadyraliev; Michel Pompeu B O Sá Journal: Braz J Cardiovasc Surg Date: 2022-03-10