Sternal Closure with Rigid Plate Fixation for Isolated Coronary Artery
Bypass Grafting: Can Sternal Plating Increase the Feasibility of
Bilateral Internal Thoracic Artery Usage in High-Risk Patients?
Objectives Long-term survival after coronary artery bypass
grafting (CABG) appears superior with bilateral internal thoracic artery
(BITA) grafting over grafting a single internal thoracic artery. BITA
grafting is recommended in CABG without excessive risk of infection.
However, there is concern about an increased risk of sternal wound
infection when BITAs are harvested. A recent report demonstrated that
sternal closure with rigid plate fixation provided better sternal
healing and fewer complications. Thus, a retrospective study was
performed to investigate whether BITA grafting can be safely performed
in CABG with rigid plate fixation for patients at high risk of sternal
wound infection. Methods From June 2017 to December 2018, a
total of 31 patients who were deemed preoperatively to be at high risk
of sternal wound infection underwent isolated CABG ± pulmonary vein
isolation. BITAs were skeletonized, and the chest was closed with rigid
plate fixation in all cases. The surgical results were retrospectively
reviewed, and the incidence of sternal wound complications was
evaluated. Results Each patient had at least 2 risk factors,
and the average number of risk factors per patient was 3.1. A total of
14 patients (45%) had obesity, with mean BMI of 31 ± 8.1 kg/m
2, and 27 patients (86%) had diabetes mellitus, with
mean HbA1c of 7.6 ± 1.5%. There was one patient with superficial
sternal wound infection (3%) and one with wound dehiscence (3%); they
were medically treated at the outpatient clinic without readmission.
There was no incidence of deep sternal wound infection.
Conclusions BITA grafting could be performed in high-risk
patients without increasing sternal wound complications. Rigid sternal
plating fixation may increase the feasibility of BITA grafting in