Ding Wen Jun, Ji Qiang, Shi Yun Qing, Ma Run Hua, Wang Chun Sheng
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China.
Cardiology. 2016;133(2):111-8. doi: 10.1159/000441137. Epub 2015 Oct 31.
To evaluate the impact of skeletonized bilateral or single internal thoracic artery (ITA) grafting on the risk of deep sternal wound infection (DSWI) in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB).
A total of 803 diabetic patients undergoing OPCAB surgery from January 2010 to December 2014 were enrolled into this study and assigned to the pSITA group (patients undergoing pedicled single ITA grafting, n = 362), the sSITA group (skeletonized single ITA grafting, n = 295), or the sBITA group (skeletonized bilateral ITA grafting, n = 146). The primary end point was the diagnosis of a DSWI.
Eighteen patients developed postoperative DSWI, with an incidence of 2.2%. Patients in the sSITA group had a significantly lower incidence of DSWI than those in the pSITA group (1.0 vs. 3.6%, p = 0.0408). In multivariate logistic regression analysis, the risk of DSWI in the sSITA group was 0.41 times that in the pSITA group.
sSITA grafting lowered the risk of DSWI in diabetic patients undergoing OPCAB surgery compared to pSITA grafting. Multicenter clinical trials involving larger sample sizes are needed to determine the merit of pSITA grafting in reducing the risk of DSWI following OPCAB surgery.
评估在接受非体外循环冠状动脉搭桥术（OPCAB）的糖尿病患者中，骨骼化双侧或单支胸廓内动脉（ITA）移植对深部胸骨伤口感染（DSWI）风险的影响。
本研究纳入了2010年1月至2014年12月期间共803例接受OPCAB手术的糖尿病患者，并将其分为带蒂单支ITA移植组（pSITA组，n = 362）、骨骼化单支ITA移植组（sSITA组，n = 295）或骨骼化双侧ITA移植组（sBITA组，n = 146）。主要终点是DSWI的诊断。
18例患者术后发生DSWI，发生率为2.2%。sSITA组患者的DSWI发生率显著低于pSITA组（1.0%对3.6%，p = 0.0408）。在多因素逻辑回归分析中，sSITA组DSWI的风险是pSITA组的0.41倍。
与pSITA移植相比，sSITA移植降低了接受OPCAB手术的糖尿病患者发生DSWI的风险。需要开展涉及更大样本量的多中心临床试验，以确定pSITA移植在降低OPCAB手术后DSWI风险方面的价值。
