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Sternal wound infections after coronary artery bypass grafting usinf bilateral skeletonized internal mammary arteries: frequency, etiology, risk factors and outcome

By Ευάγγελος Ροσμαράκης

Abstract

Coronary artery bypass on a beating heart (off-pump coronary artery bypass grafting or OPCABG) has become common in the last ten years in an attempt to decrease the complications associated with the use of extracorporeal circulation. There is also evidence that a new technique of OPCABG, which is performed with the use of bilateral skeletonized internal mammary arteries avoiding any procedure on the ascending aorta and a sternal closure technique based on alternative placement of figure of eight and single sternal wires, can further decrease sternal wound infections. In the retrospective part of the study, we examined the frequency, characteristics, and predisposing factors of postoperative infections, in a large cohort of patients undergoing OPCABG surgery over a period of 39 months (January 2001 - March 2004) at “Henry Dunant” Hospital, Athens, Greece. Cases were patients who developed microbiologically documented nosocomial infection. Patients who underwent valve surgery combined with coronary artery bypass surgery were excluded from the study. Twenty-one of 782 (2.7%) studied patients developed microbiologically documented nosocomial infection after OPCABG. Six of 782 studied patients (0,77%) developed sternal wound infection [4 (0.51%) developed superficial wound infection and 2 (0.26%) mediastinitis], 8 patients (1.02%) developed pneumonia, 7 (0.90%) bacteremia, 4 (0.51%) urinary tract infection (UTI), and 1 (0.13%) developed pressure sore infection. Four patients had infections at two or more different sites. Specifically, 1 patient had UTI and mediastinitis, 1 UTI and pressure sore infection, 1 pneumonia and bacteremia, and 1 pneumonia, urinary tract infection, and bacteremia. Thus, there were 26 episodes of microbiologically documented infections in 21 patients. The backward stepwise multivariable logistic regression model revealed that independent risk factors associated with development of microbiologically documented nosocomial infection were arterial hypertension, previous vascular surgery, urgent operation, postoperative atrial fibrillation, number of inotrops used during operation and after operation, transfusions of fresh frozen plasma during ICU stay and ICU stay until development of infection. ...............

Topics: Λοιμώξεις στερνοτομής, Αμφοτερόπλευρες έσω μαστικές αρτηρίες, Αορτοστεφανιαία παράκαμψη, Λοιμώξεις μετά από καρδιοχειρουργική επέμβαση, Αποσκελετωμένες έσω θωρακικές αρτηρίες, Μεσοθωρακίτιδα, Sternal wound infections, Skeletonized internal mammary arteries, Bilateral internal thoracic arteries, Off-pump coronary artery bypass grafting, OPCABG, Infections after coronary artery bypass, Mediastinitis
Publisher: University of Crete (UOC)
Year: 2011
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