| 要約: | Objective(s)<br/> The question of whether skeletonized internal mammary artery (IMA) harvesting reduces the incidence of sternal wound complications in comparison to the pedicled technique, in the context of single or bilateral IMAs, remains controversial. We studied the impact IMA harvesting strategy on sternal wound complication in the Arterial Revascularization Trial (ART). <br/><br/> Methods<br/> Patients enrolled in the ART (n=3102) were randomised to coronary artery bypass grafting with single or bilateral IMAs. Sternal wound complication rates were examined according to the harvesting technique that was documented in 2056 patients. The IMA harvesting technique, based on surgeon preference, resulted in 4 groups: pedicled single IMA (P-SIMA, n=607), pedicled bilateral IMA (P-BIMA, n=459), skeletonized single IMA (S-SIMA, n=512) and skeletonized bilateral IMA (S-BIMA, n=478). Propensity Scores weighting was used to estimate the impact of the harvesting technique on sternal wound complications. <br/><br/> Results<br/> A total of 219 of 2056 patients (10.6%) experienced a sternal wound complication within 1 year from the index operation. Of those, only 25 (1.2%) patients required sternal wound reconstruction. P-BIMA (OR 1.80; 95%CI 1.23 to 2.63) but not S-BIMA (OR 1.00; 95%CI 0.65 to 1.53) or S-SIMA (OR 0.89; 95%CI 0.57-1.38) was associated with a significantly increased risk of any sternal wound complications compared to P-SIMA. <br/><br/> Conclusions<br/> The present ART sub-study suggests that, with a skeletonization technique, the risk of sternal wound complication with BIMA grafting is similar to that after standard pedicled SIMA harvesting whilst skeletonized SIMA harvesting did not add any further benefit when compared to pedicled SIMA harvesting.
|
|---|