Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate

Marco Agrifoglio¹ , Matteo Trezzi¹ , Fabio Barili¹ , Luca Dainese¹ , Faisal H Cheema² , Veli K Topkara² , Chiara Ghislandi¹ , Alessandro Parolari¹ , Gianluca Polvani¹ , Francesco Alamanni¹ and Paolo Biglioli¹

¹Department of Cardiovascular Surgery, Centro Cardiologico Monzino, University of Milan, Via Parea 4, 20138 Milan, Italy

²Division of Cardiothoracic Surgery, College of Physicians and Surgeon of Columbia University – New York Presbyterian Hospital, Columbia University Medical Center, Milstein Hospital Building, 7GN-435, 177 Fort Washington Avenue, New York, NY 10032, USA

author email corresponding author email

Journal of Cardiothoracic Surgery 2008, 3:35doi:10.1186/1749-8090-3-35


Published:	23 June 2008

Abstract

Background

The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia.

Methods

81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%), BITAs were harvested in 40 (Group 2, 49.4%). The major clinical end points analyzed in this study were infection rate, type of infection, duration of infection, infection relapse rate and total hospital length of stay.

Results

Five patients developed sternal SSI in the perioperative period, 2 in group 1 and 3 in group 2 without significant difference. All sternal SSIs were superficial with no sternal dehiscence. The development of infection from the time of surgery took 18.5 ± 2.1 and 7.3 ± 3.0 days for Groups 1 and 2 respectively. The infections were treated with wound irrigation and debridement, and with VAC therapy as well as with antibiotics. The VAC system was removed after a mean of 12.8 ± 5.1 days, when sterilization was achieved. The overall survival estimate at 1 year was 98.7%. Only BMI was a significant predictor of SSI using multivariate stepwise logistic regression analysis (Odds Ratio: 1.34; 95%Conficdence Interval: 1.02–1.83; p value: 0.04). In the model, the use of BITA was not an independent predictor of SSI.

Conclusion

CABG with bilateral pedicled ITAs grafting could be performed safely even in diabetics with poor preoperative glycaemic control.