Negative Pressure versus Conventional Sternal Wound Dressing in Coronary Surgery Using Bilateral Internal Mammary Artery Grafts

  • Vito Giovanni Ruggieri Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France
  • Maud-Emmanuelle Olivier Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France
  • Chaudi Aludaat Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France
  • Stefano Rosato Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
  • Paul Marticho Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France
  • Yves Assad Saade Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France
  • Annick Lefebvre Equipe Opérationnelle d’Hygiène, CHU Reims, Hôpital Maison Blanche, Reims, France
  • Anne Poncet Unité d’Anesthésie-Réanimation Cardio-Thoracique, Robert Debré University Hospital, Reims, France
  • Sylvain Rubin Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France
  • Fausto Biancari Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland

Abstract

Background: Sternal wound infection (SWI) is a major complication occurring often after coronary artery bypass grafting (CABG) using bilateral internal mammary artery (BIMA) grafts. The aim of this study is to assess whether such a risk may be reduced by using incision negative pressure wound therapy (INPWT).

Methods: Data on patients undergoing isolated CABG using BIMA grafts at the Reims University Hospital, France, from 2013 to 2016 without or with INPWT was prospectively collected. 

Results: INPWT was used in 161 patients and conventional sterile wound dressing was used in 266 patients. Propensity score matching resulted in 128 pairs with similar characteristics. SWIs were similarly distributed between the conventional sterile wound dressing (10.9%) and the INPWT cohorts (10.2%) (P = 1.00). Patients treated with INPWT had a lower rate of deep SWI/mediastinitis than patients who had conventional sterile dressing (5.5% versus 10.2%, P = .210), but the difference did not reach statistical significance. Tests for interaction confirmed these findings in different patient subgroups.

Conclusion: The routine use of INPWT may not significantly reduce the risk of SWI in patients undergoing BIMA grafting. In view of previous reports showing a benefit with the use of this method, a large randomized study is justified to assess the efficacy of INPWT in patients undergoing cardiac surgery.

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Published
2019-02-25
Section
Articles