Korean J Thorac Cardiovasc Surg.  2015 Feb;48(1):33-39. 10.5090/kjtcs.2015.48.1.33.

Sternal Healing after Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries: Assessment by Computed Tomography Scan

• Shin YC
• Kim SH
• Kim DJ
• Kim DJ
• Kim JS
• Lim C
• Park KH

• KMID: 2382223
• DOI: http://doi.org/10.5090/kjtcs.2015.48.1.33

Abstract

BACKGROUND
This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries.
MATERIALS AND METHODS
This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing.
RESULTS
Three to six months after surgery, the average total score of sternal healing was 2.07+/-1.52 and 68 patients (34.5%) showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to 5.88+/-0.38 and complete healing was observed in 98.2% of patients.
CONCLUSION
Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium.

Keyword

Coronary artery bypass; Wound healing; Mammary arteries; Computed tomography

MeSH Terms

Angiography
Coronary Artery Bypass*
Diabetes Mellitus
Humans
Incidence
Mammary Arteries*
Manubrium
Medical Records
Multivariate Analysis
Retrospective Studies
Skeleton
Sternotomy
Sternum
Transplants
Wound Healing