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• W4240821818 abstract "We welcome the Letter to the Editor from Santarpino and colleagues [1Santarpino G. Gazdag L. Vogt F. Ledwon M. Randomized study for mammary artery harvesting: please, also consider wound management!.Ann Thorac Surg. 2016; 101 (letter): 2025Abstract Full Text Full Text PDF Scopus (2) Google Scholar], which discusses our recent review of the effect of various internal mammary artery harvesting techniques on sternal perfusion [2Cheng K. Rehman S.M. Taggart D.P. A review of differing techniques of mammary artery harvesting on sternal perfusion: time for a randomized study?.Ann Thorac Surg. 2015; 100: 1942-1953Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar]. These investigators report their own study involving the use of negative pressure wound therapy to reduce the risk of sternal wound complications in patients undergoing coronary artery bypass graft surgery with bilateral internal mammary artery (BIMA) grafts. It merits congratulations that they achieved a reduction in the incidence of sternal wound infection from 5.6% to 0% at 30 days that although not ”statistically significant” would be clinically very important. Indeed, several intraoperative methods can be used to reduce the risk of sternal wound complications, such as particular skin and sternal suturing techniques and the application of topical antibacterial agents, and these methods have been previously discussed by our institution [3Rehman S.M. Elzain O. Mitchell J. et al.Risk factors for mediastinitis following cardiac surgery: the importance of managing obesity.J Hosp Infect. 2014; 88: 96-102Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar]. The important point is that although there is an associated increased risk of sternal wound complication, the use of BIMA grafts has been shown to improve long-term survival compared with the use of a single internal mammary artery [4Taggart D.P. Altman D.G. Gray A.M. et al.Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART).Eur Heart J. 2010; 31: 2470-2481Crossref PubMed Scopus (299) Google Scholar, 5Yi G. Shine B. Rehman S.M. Altman D.G. Taggart D.P. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach.Circulation. 2014; 130: 539-545Crossref PubMed Scopus (216) Google Scholar]. Therefore, the increased risk of sternal wound complications associated with BIMA grafts should not discourage surgeons from employing such a revascularization strategy; rather, this strategy should be managed with appropriate preoperative planning, intraoperative technique, and postoperative wound management, such as that described by Santarpino and colleagues. Randomized Study for Mammary Artery Harvesting: Please, Also Consider Wound Management!The Annals of Thoracic SurgeryVol. 101Issue 5PreviewAccording to current guidelines from the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery, patients undergoing surgical revascularization are at high risk of sternal wound infection. In addition, although available evidence clearly suggests that bilateral internal mammary artery (BIMA) grafting provides superior revascularization to single left internal mammary artery (LIMA) grafting in terms of survival and quality of life, only a small number of patients are offered this treatment [1]. Full-Text PDF" @default.
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• W4240821818 date "2016-05-01" @default.
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• W4240821818 doi "https://doi.org/10.1016/j.athoracsur.2015.11.013" @default.
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