|Risk Factors and
Treatment for Mediastinitis in Internal Mammary Artery Grafting,
with Particular Regard to Diabetic Patients
(Department of Cardiovascular Surgery, Okayama University
Medical School, Okayama, Japan and Department of Cardiovascular
Surgery, Cardiac Center Sakakibara Hospital, Okayama, Japan)
|The internal mammary artery (IMA)
has been widely used in CABG due to the excellent long-term results.
However, the extensive use of bilateral IMA grafting has been
believed to increase operative morbidity and mortality. This
study was designed to determine if bilateral IMA grafting in
diabetic patients increased the likelihood of mediastinitis.
We analyzed the data of 386 consecutive patients who underwent
isolated CABG in 1992 to 1996. The definitions of sternal wound
complications are as follows, (P) mediastinal dehiscence and
(Q) mediastinal wound infection. Subtypes include superficial
wound infection and deep wound infection (mediastinitis). Among
these patients 97 received unilateral IMA grafts and 289 did
bilateral IMA grafts. Mediastinitis did not occur in any subjects.
The occurrence rate of mediastinal dehiscence and superficial
wound infection was 7.2% (7/97) for bilateral IMA grafting, 7.3%
(21/289) for unilateral IMA grafting. No patients died of wound
complications. The occurrence rate of mediastinal dehiscence
and superficial wound infections were 12.0% (4/33) for bilateral
IMA grafting in diabetic patients, 12.0% (14/117) for unilateral
IMA grafting in diabetic patients. That of this complications
was 4.7% (3/64) for bilateral IMA grafting in non-diabetic patients,
4.1% (7/172) for unilateral IMA grafting in diabetic patients,
without significant differences in wound complication. Bilateral
IMA grafting in diabetic patients carried no great risk of mediastinitis,
but diabetes mellitus itself was a great risk for mediastinitis.
@Jpn. J. Cardiovasc. Surg. 29: 5-9 (2000)