Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2019 Jan;157(1):166-173.e1. doi: 10.1016/j.jtcvs.2018.06.101. Epub 2018 Sep 7.
Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). The present study investigated the early outcome of BITA grafting and analyzed the risk of DSWI using a Japanese national database (the Japan Adult Cardiovascular Surgery Database).
Data from 560 hospitals were used. Between April 2012 and December 2015, BITA was harvested in 14,249 patients, corresponding to 32.6% of isolated coronary artery bypass cases. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple logistic regression analysis was employed to model the risk of DSWI.
The mean age was 67.1 years. The prevalence of diabetes, renal failure, hemodialysis, and liver dysfunction was 51.8%, 21.2%, 7.8%, and 1.2%, respectively. The incidence of DSWI and operative mortality was 1.6 (234 patients) and 1.6% (226 patients), respectively. The operative mortality rate in patients with DSWI was 13.7% (32 patients). The off-pump technique was used in 72.8%, with a conversion rate of 2.5%. Female sex, diabetes mellitus, chronic lung disease, renal failure, liver dysfunction, ejection fraction ≤60%, shock status, reoperation, preoperative intra-aortic balloon pump use, and an increased operative time were independent risk factors for DSWI after BITA grafting. The off-pump technique did not reduce the risk of DSWI.
The present study showed that early outcomes of BITA grafting were satisfactory regarding DSWI and operative mortality. The current data are informative to predict the risk of DSWI when performing BITA grafting.
尽管双侧胸廓内动脉（BITA）搭桥术具有生存获益，但由于对深部胸骨伤口感染（DSWI）的担忧，其并未广泛应用。本研究利用日本全国数据库（日本成人心血管外科学数据库），调查了 BITA 搭桥术的早期结果，并分析了 DSWI 的风险。
使用了 560 家医院的数据。2012 年 4 月至 2015 年 12 月，14249 例患者接受了 BITA 搭桥术，占单纯冠状动脉旁路移植术病例的 32.6%。DSWI 定义为需要手术干预和/或使用抗生素的伤口感染。采用多因素逻辑回归分析来建立 DSWI 的风险模型。
患者的平均年龄为 67.1 岁。糖尿病、肾衰竭、血液透析和肝功能不全的患病率分别为 51.8%、21.2%、7.8%和 1.2%。DSWI 和手术死亡率分别为 1.6%（234 例）和 1.6%（226 例）。DSWI 患者的手术死亡率为 13.7%（32 例）。非体外循环技术的使用率为 72.8%，转化率为 2.5%。女性、糖尿病、慢性肺部疾病、肾衰竭、肝功能不全、射血分数≤60%、休克状态、再次手术、术前主动脉内球囊泵使用和手术时间延长是 BITA 搭桥术后 DSWI 的独立危险因素。非体外循环技术并不能降低 DSWI 的风险。
本研究表明，BITA 搭桥术的早期结果在 DSWI 和手术死亡率方面令人满意。目前的数据有助于预测 BITA 搭桥术时 DSWI 的风险。
