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Semi-skeletonized Internal Mammary Artery Grafts and Sternal Wound Complications

Department of Cardiothoracic Surgery, Westmead Hospital
¹ Westmead Millennium Institute, Westmead, Australia

For reprint information contact: Hugh S Paterson, FRACS Tel: 61 2 9845 7994 Fax: 61 2 9845 8314 Email: patersonH{at}aol.com Department of Cardiothoracic Surgery, Westmead Hospital, P.O. Box 533, Wentworthville, New South Wales 2145, Australia.

This study aimed to evaluate the risk factors for sternal wound complications in patients undergoing myocardial revascularization using bilateral semi-skeletonized internal mammary arteries. Prospectively collected data on 751 patients undergoing coronary artery surgery from September 1994 to August 2002 were analyzed. The mean age of the patients was 56 years, 633 (84%) were male, 44 (6%) were over 66 years of age, and 170 (23%) were diabetic. Forty-four (5.9%) patients developed sternal wound complications. Among these cases, sternal infection occurred in 22 (2.9%) patients, of which 15 (2.0%) had sternal infection with mediastinitis and 7 (0.9%) had sternal infection alone. Independent risk factors for any sternal wound complications were peripheral vascular disease, diet-controlled diabetes, and delayed sternal closure. The risk factors for sternal infection were diabetes, postoperative pulmonary complications, and postoperative stroke. The perioperative mortality rate was 1.5% (11 patients), including 2 patients who had sternal wound complications. The use of bilateral semi-skeletonized internal mammary artery conduits carries a comparable sternal wound complication rate as conduits harvested by other techniques.