Yonsei Med J.  2009 Feb;50(1):78-82. 10.3349/ymj.2009.50.1.78.

Does Bilateral Pedicle Internal Thoracic Artery Harvest Increase the Risk of Mediastinitis?

• Choo SJ
• Lee SK
• Chung SW
• Kim JW
• Sung SC
• Kim YD
• Bae MJ
• Kim JH
• Chon KJ
• Lee HC

• KMID: 1782971
• DOI: http://doi.org/10.3349/ymj.2009.50.1.78

Abstract

PURPOSE
Bilateral in situ internal thoracic artery (ITA) bypassing may result in excellent myocardial revascularization without increasing the risk of deep sternal wound infection. Although there have been concerns with the use of pedicled bilateral ITA, the risk of infection may not be greater than the use of skeletonized ITA.
MATERIALS AND METHODS
The present study was retrospectively undertaken to determine if pedicled BITA grafts are associated with a higher risk of sternal wound complications. A total of 207 patients who underwent bilateral ITA bypasses with or without existing diabetes mellitus, and 162 patients of those received bilateral pedicled ITA and 98 patients received unilateral ITA bypass grafts.
RESULTS
No sternal wound complications were noted in either the bilateral ITA or unilateral left ITA groups.
CONCLUSION
Bilateral pedicled ITA harvesting was not associated with a greater incidence of infectious sternal complications compared to patients receiving unilateral ITA bypass grafts.

Keyword

Internal thoracic arteries; coronary artery bypass; surgical wound infection; sternum

MeSH Terms

Aged
Coronary Artery Disease/epidemiology/*surgery
Diabetes Mellitus/epidemiology
Female
Humans
*Internal Mammary-Coronary Artery Anastomosis/statistics & numerical data
Male
Mammary Arteries/*transplantation
Mediastinitis/*epidemiology
Middle Aged
Retrospective Studies
Risk Factors
Sternum
Surgical Wound Infection/epidemiology
Tissue and Organ Harvesting/*adverse effects/statistics & numerical data

Reference

1. Lytle BW, Loop FD. Superiority of bilateral internal thoracic artery grafting: it's been a long time comin'. Circulation. 2001. 104:2152–2154.

2. Buxton BF, Komeda M, Fuller JA, Gordon I. Bilateral internal thoracic artery grafting may improve outcome of coronary artery surgery. Risk-adjusted survival. Circulation. 1998. 98:19 Suppl. II1–II6.

3. De Paulis R, de Notaris S, Scaffa R, Nardella S, Zeitani J, Del Giudice C, et al. The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization. J Thorac Cardiovasc Surg. 2005. 129:536–543.

4. Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg. 1998. 65:1050–1056.

5. Fiore AC, Naunheim KS, McBride LR, Peigh PS, Pennington DG, Kaiser GC, et al. Fifteen-year follow-up for double internal thoracic artery grafts. Eur J Cardiothorac Surg. 1991. 5:248–252.

6. Peterson MD, Borger MA, Rao V, Peniston CM, Feindel CM. Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. J Thorac Cardiovasc Surg. 2003. 126:1314–1319.

7. Dion R, Etienne PY, Verhelst R, Khoury G, Rubay J, Bettendorff P, et al. Bilateral mammary grafting. Clinical, functional and angiographic assessment in 400 consecutive patients. Eur J Cardiothorac Surg. 1993. 7:287–293. discussion 294.

8. Tector AJ, Amundsen S, Schmahl TM, Kress DC, Peter M. Total revascularization with T grafts. Ann Thorac Surg. 1994. 57:33–38. discussion 39.

9. Berreklouw E, Rademakers PP, Koster JM, van Leur L, van der Wielen BJ, Westers P. Better ischemic eventfree survival after two internal thoracic artery grafts: 13 years of follow-up. Ann Thorac Surg. 2001. 72:1535–1541.

10. Schmidt SE, Jones JW, Thornby JI, Miller CC 3rd, Beall AC Jr. Improved survival with multiple left-sided bilateral internal thoracic artery grafts. Ann Thorac Surg. 1997. 64:9–14. discussion 15.

11. Burfeind WR Jr, Glower DD, Wechsler AS, Tuttle RH, Shaw LK, Harrell FE Jr, et al. Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial. Circulation. 2004. 110:11 Suppl. II27–II35.

12. Hirotani T, Shirota S, Cho Y, Takeuchi S. Feasibility and suitability of the routine use of bilateral internal thoracic arteries. Ann Thorac Surg. 2002. 73:511–515.

13. Gansera B, Schiller M, Kiask T, Angelis L, Neumaier-Prauser P, Kemkes BM. Internal thoracic artery vs. vein grafts-postoperative angiographic findings in symptomatic patients after 1000 days. Thorac Cardiovasc Surg. 2003. 51:239–243.

14. Dion R, Glineur D, Derouck D, Verhelst R, Noirhomme P, El Khoury G, et al. Long-term clinical and angiographic follow up of sequential internal thoracic artery grafting. Eur J Cardiothorac Surg. 2000. 17:407–414.

15. Tavilla G, Kappetein AP, Braun J, Gopie J, Tjien AJ, Dion RA. Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries. Ann Thorac Surg. 2004. 77:794–799. discussion 799.

16. Mert M, Erdem CC, Babalik E, Bakay C. Mid-to-long-term patency comparison of the right internal thoracic artery grafts on the left anterior descending and on the right coronary arteries. Thorac Cardiovasc Surg. 2003. 51:180–184.

17. Endo M, Nishida H, Tomizawa Y, Kasanuki H. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation. 2001. 104:2164–2170.

18. Stevens LM, Carrier M, Perrault LP, Hébert Y, Cartier R, Bouchard D, et al. Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival. J Thorac Cardiovasc Surg. 2004. 127:1408–1415.

19. Gansera B, Schmidtler F, Gillrath G, Angelis I, Wenke K, Weingartner J, et al. Does bilateral ITA grafting increase perioperative complications? Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass. Eur J Cardiothorac Surg. 2006. 30:318–323.

20. Seyfer AE, Shriver CD, Miller TR, Graeber GM. Sternal blood flow after median sternotomy and mobilization of the internal mammary arteries. Surgery. 1988. 104:899–904.

21. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg. 1996. 111:1200–1207.

22. Athanasiou T, Crossman MC, Asimakopoulos G, Cherian A, Weerasinghe A, Glenville B, et al. Should the internal thoracic artery be skeletonized? Ann Thorac Surg. 2004. 77:2238–2246.

23. Henriquez-Pino JA, Gomes WJ, Prates JC, Buffolo E. Surgical anatomy of the internal thoracic artery. Ann Thorac Surg. 1997. 64:1041–1045.

24. Ura M, Sakata R, Nakayama Y, Arai Y. Bilateral pedicled internal thoracic artery grafting. Eur J Cardiothorac Surg. 2002. 21:1015–1019.