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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 1096-1099, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SR Hazelrigg, HA Wellons Jr, JA Schneider and P Kolm
Case histories of 2582 patients requiring median sternotomy for coronary
artery bypass grafting between January 1982 and August 1986 were
retrospectively reviewed. Only saphenous vein grafts were used in 230
patients, one mammary artery graft was used in 1626 patients, and both
mammary arteries were used in 726 patients. The relationship of potential
risk factors and wound complication was evaluated. The overall incidence of
wound complications was 0.81%-0.43% in the saphenous vein graft group,
0.49% in the single mammary group, and 1.65% in the bilateral mammary
group. Graft type and a number of potential risk factors were analyzed in a
logistic regression analysis to determine significant predictors of wound
complications. The results indicated that pneumonia, obesity,
reexploration, use of the intraaortic balloon pump, and diabetes were
significant risk factors contributing to the probability of wound
complications. Bilateral mammary grafting was significantly associated with
the increased probability of a wound complication developing. Bilateral
mammary grafting increased the chance of wound complication nearly five
times that of saphenous vein grafting and three times that of single
mammary grafting. Mammary artery grafts have been shown to achieve greater
long- term patency than saphenous vein grafts, and their continued use is
encouraged. However, the potential for increased wound problems should be
considered along with other significant preoperative risk factors such as
insulin-dependent diabetes, chronic pulmonary disease, and obesity.
ARTICLES
Wound complications after median sternotomy. Relationship to internal mammary grafting
Prairie Cardiovascular Center, Southern Illinois University School of Medicine, Springfield 62794-9420.
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