Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries
Background: Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher sur...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/11/457 |
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| author | Mircea Robu Bogdan Rădulescu Irina Margarint Ovidiu Știru Iulian Antoniac Daniela Gheorghiță Cristian Voica Claudia Nica Mihai Cacoveanu Luminița Iliuță Vlad Anton Iliescu Horațiu Moldovan |
| author_facet | Mircea Robu Bogdan Rădulescu Irina Margarint Ovidiu Știru Iulian Antoniac Daniela Gheorghiță Cristian Voica Claudia Nica Mihai Cacoveanu Luminița Iliuță Vlad Anton Iliescu Horațiu Moldovan |
| author_sort | Mircea Robu |
| collection | DOAJ |
| description | Background: Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher survival rates when using bilateral mammary arteries, multiple studies report a higher rate of surgical site infections, most notably deep sternal wound infections, a so-called “never event”. Methods: We designed a prospective study between 1 January 2022 and 31 December 2022 and included all patients proposed for total arterial myocardial revascularization in order to investigate the rate of surgical site infections (SSI). Chest closure in all patients was performed using a three-step protocol. The first step refers to sternal closure. If the patient’s BMI is below 35 kg/m<sup>2</sup>, sternal closure is achieved using the “butterfly” technique with standard steel wires. If the patient’s BMI exceeds 35 kg/m<sup>2</sup>, we use nitinol clips or hybrid wire cable ties according to the surgeon’s preference for sternal closure. The main advantages of these systems are a larger implant-to-bone contact with a reduced risk of bone fracture. The second step refers to presternal fat closure with two resorbable monofilament sutures in a way that the edges of the skin perfectly align at the end. The third step is skin closure combined with negative pressure wound therapy. Results: This system was applied to 217 patients. A total of 197 patients had bilateral mammary artery grafts. We report only 13 (5.9%) superficial SSI and only one (0.46%) deep SSI. The preoperative risk of major wound infection was 3.9 +/− 2.7. Bilateral mammary artery grafting was not associated with surgical site infection in a univariate analysis. Conclusions: We believe this strategy of sternal wound closure can reduce the incidence of deep surgical site infection when two mammary arteries are used in coronary artery bypass surgery. |
| first_indexed | 2024-03-09T16:43:59Z |
| format | Article |
| id | doaj.art-6562384ce2bf4d3ea88c1bf5e8ee26e7 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T16:43:59Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-6562384ce2bf4d3ea88c1bf5e8ee26e72023-11-24T14:48:51ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-11-01101145710.3390/jcdd10110457Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary ArteriesMircea Robu0Bogdan Rădulescu1Irina Margarint2Ovidiu Știru3Iulian Antoniac4Daniela Gheorghiță5Cristian Voica6Claudia Nica7Mihai Cacoveanu8Luminița Iliuță9Vlad Anton Iliescu10Horațiu Moldovan11Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, RomaniaFaculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, RomaniaDepartment of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, RomaniaDepartment of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, RomaniaDepartment of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, RomaniaDepartment of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, RomaniaFaculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaBackground: Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher survival rates when using bilateral mammary arteries, multiple studies report a higher rate of surgical site infections, most notably deep sternal wound infections, a so-called “never event”. Methods: We designed a prospective study between 1 January 2022 and 31 December 2022 and included all patients proposed for total arterial myocardial revascularization in order to investigate the rate of surgical site infections (SSI). Chest closure in all patients was performed using a three-step protocol. The first step refers to sternal closure. If the patient’s BMI is below 35 kg/m<sup>2</sup>, sternal closure is achieved using the “butterfly” technique with standard steel wires. If the patient’s BMI exceeds 35 kg/m<sup>2</sup>, we use nitinol clips or hybrid wire cable ties according to the surgeon’s preference for sternal closure. The main advantages of these systems are a larger implant-to-bone contact with a reduced risk of bone fracture. The second step refers to presternal fat closure with two resorbable monofilament sutures in a way that the edges of the skin perfectly align at the end. The third step is skin closure combined with negative pressure wound therapy. Results: This system was applied to 217 patients. A total of 197 patients had bilateral mammary artery grafts. We report only 13 (5.9%) superficial SSI and only one (0.46%) deep SSI. The preoperative risk of major wound infection was 3.9 +/− 2.7. Bilateral mammary artery grafting was not associated with surgical site infection in a univariate analysis. Conclusions: We believe this strategy of sternal wound closure can reduce the incidence of deep surgical site infection when two mammary arteries are used in coronary artery bypass surgery.https://www.mdpi.com/2308-3425/10/11/457coronary artery bypass grafting (CABG)sternal closuresternal osteosynthesis |
| spellingShingle | Mircea Robu Bogdan Rădulescu Irina Margarint Ovidiu Știru Iulian Antoniac Daniela Gheorghiță Cristian Voica Claudia Nica Mihai Cacoveanu Luminița Iliuță Vlad Anton Iliescu Horațiu Moldovan Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries Journal of Cardiovascular Development and Disease coronary artery bypass grafting (CABG) sternal closure sternal osteosynthesis |
| title | Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries |
| title_full | Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries |
| title_fullStr | Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries |
| title_full_unstemmed | Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries |
| title_short | Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries |
| title_sort | surgical strategy for sternal closure in patients with surgical myocardial revascularization using mammary arteries |
| topic | coronary artery bypass grafting (CABG) sternal closure sternal osteosynthesis |
| url | https://www.mdpi.com/2308-3425/10/11/457 |
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