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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 342-346, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
EA Grossi, R Esposito, LJ Harris, GA Crooke, AC Galloway, SB Colvin, AT Culliford, FG Baumann, K Yao and FC Spencer
Previous studies have provided conflicting evidence as to whether an
increased risk of mediastinitis is associated with use of the internal
mammary artery as a coronary bypass graft. In this study the effects of
internal mammary artery grafts on wound complications were analyzed in a
prospective, nonrandomized fashion. At New York University Medical Center
from January 1985 through May 1988, 2356 patients underwent isolated
coronary revascularization. Among these patients 1394 received one or more
internal mammary artery grafts (group I) and 962 had vein grafts only
(group II). Group I had a mean age of 59.5 years versus 67.7 years in group
II; diabetes was equally present in both groups (22.7% versus 24.7%).
Operative mortality rate was 1.3% in group I and 5.6% in group II. Sternal
infection was significantly more prevalent in group I (2.2%, 31/1394) than
in group II (0.8%, 8/962). Multivariate analysis revealed that aortic
crossclamp time, use of a single internal mammary artery graft, use of a
double mammary graft, and diabetes were associated with increased risk of
sternal infection. The use of bilateral internal mammary artery grafting
doubled the odds ratio of the risk compared with use of a single mammary
graft, and the combination of diabetes and double internal mammary artery
grafts increased the odds ratio 13.9-fold. Patients with an internal
mammary artery graft who had sternal infection had a longer period of
hospitalization than patients without a mammary artery graft who had
sternal infection. We conclude that the risk of sternal infection is
increased by the use of an internal mammary artery graft, especially use of
double mammary grafts in the presence of diabetes.
ARTICLES
Sternal wound infections and use of internal mammary artery grafts
Department of Surgery, New York University Medical Center, N.Y. 10016.
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