Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
Department of Cardiovascular Surgery, Faculdade Estadual de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
Braz J Cardiovasc Surg. 2021 Aug 6;36(4):500-505. doi: 10.21470/1678-9741-2020-0292.
Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up.
This is a retrospective review of the medical records of 152 patients undergoing elective CABG with the use of BITA and cardiopulmonary bypass (CPB). These patients were divided into two groups, diabetics and non-diabetics. Patients with acute myocardial infarction and concomitant valvular disease were not included in the sample.
Preoperative characteristics did not show significant differences between the groups, which allowed a comparative analysis. The variables electrocardiography time and aortic clamping time were higher in the diabetic group, with a significant statistical difference (P<0.0001). In-hospital mortality occurred in three patients, and there was no mortality up to 30 days in both groups. There was no significant difference in the primary end point between groups (P=0.56). Deep sternal wound infection was present in only one patient and showed no significant difference in the secondary outcome between groups (P=0.40).
We did not observe a higher mortality and occurrence of deep sternal wound infection with the use of BITA in diabetic patients compared to non-diabetics, even with greater CPB and aortic clamping times in diabetics.
在冠状动脉旁路移植术（CABG）中使用双侧胸廓内动脉（BITA）作为移植物存在争议，因为它与更高的院内死亡率、胸骨伤口相关感染的发生率以及手术时间的增加有关。本研究的主要目的是评估住院期间死亡率和出院后 30 天内死亡率。次要目标是评估 90 天随访时深部胸骨伤口感染的发生情况。
这是对 152 例行择期 CABG 并使用 BITA 和体外循环（CPB）的患者的病历进行的回顾性分析。这些患者被分为两组，即糖尿病患者和非糖尿病患者。不包括急性心肌梗死和合并瓣膜疾病的患者。
术前特征在两组之间无显著差异，允许进行比较分析。糖尿病组心电图时间和主动脉钳夹时间较高，具有显著统计学差异（P<0.0001）。住院期间有 3 例死亡，两组均无 30 天内死亡。主要终点两组之间无显著差异（P=0.56）。仅 1 例患者出现深部胸骨伤口感染，两组次要结局无显著差异（P=0.40）。
与非糖尿病患者相比，糖尿病患者使用 BITA 并未观察到更高的死亡率和深部胸骨伤口感染发生率，尽管糖尿病患者的 CPB 和主动脉钳夹时间更长。
