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

Authors

  • 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

DOI:

https://doi.org/10.1532/hsf.2269

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.

References

Atkins BZ, Wooten MK, Kistler J, et al. 2009. Does negative pressure wound therapy have a role in preventing poststernotomy wound complications? Surg Innov 16:140-6.

Colli A, Camara ML. 2011 First experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients. J Cardiothorac Surg 6:160.

Deo SV, Altarabsheh SE, Shah IK, et al. 2015. Are two really always better than one? Results, concerns and controversies in the use of bilateral internal thoracic arteries for coronary artery bypass grafting in the elderly: a systematic review and meta-analysis. Int J Surg 16:Pt B,163-70.

Grauhan O, Navasardyan A, Hofmann M, et al. 2013. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg 145:1387-92.

Grauhan O, Navasardyan A, Tutkun B, et al. 2014. Effect of surgical incision management on wound infections in a poststernotomy patient population. Int Wound J 11:suppl 1,6-9. Kouchoukos NT, Wareing TH, Murphy SF, et al. 1990. Risks of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 49:210-17.

Li PY, Yang D, Liu D, et al. 2017. Reducing surgical site infection with negative-pressure wound therapy after open abdominal surgery: a prospective randomized controlled study. Scand J Surg 106:189-95.

Lytle BW, Blackstone EH, Loop FD, et al. 1999. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855-72.

Mangram AJ, Horan TC, Pearson ML, et al. 1999. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250-78.

Manoharan V, Grant AL, Harris AC, et al. 2016. Closed incision negative pressure wound therapy vs conventional dry dressings after primary knee arthroplasty: a randomized controlled study. J Arthroplasty 31:2487-94.

Masden D, Goldstein J, Endara M, et al. 2012. Negative pressure wound therapy for at-risk surgical closures in patients with multiple comorbidities: a prospective randomized controlled study. Ann Surg 255:1043-7.

Mastrobuoni S, Gawad N, Price J, et al. 2012. Use of bilateral internal thoracic artery during coronary artery bypass graft surgery in Canada: the bilateral internal thoracic artery survey. J Thorac Cardiovasc Surg 144:874-9.

Nashef SA, Roques F, Sharples LD, et al. 2012. EuroSCORE II. Eur J Cardiothorac Surg 41:734-44.

O’Leary DP, Peirce C, Anglim B, et al. 2017. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations: a randomized, controlled, open-label trial: The P.I.C.O. Trial. Ann Surg 265:1082-6.

Online STS Adult Cardiac Surgery Risk Calculator. http://riskcalc.sts.org/stswebriskcalc/#/. [Accessed June 2017].

Parish MA, Asai T, Grossi EA, et al. 1992. The effects of different techniques of internal mammary artery harvesting on sternal blood flow. J Thorac Cardiovasc Surg 104:1303-7.

Sajja LR. 2015. Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting. Int J Surg 16:Pt B,171-8.

Shen P, Blackham AU, Lewis S, et al. 2017. Phase II randomized trial of negative-pressure wound therapy to decrease surgical site infection in patients undergoing laparotomy for gastrointestinal, pancreatic, and peritoneal surface malignancies. J Am Coll Surg 224:726-37.

Published

2019-02-25

How to Cite

Ruggieri, V. G., Olivier, M.-E., Aludaat, C., Rosato, S., Marticho, P., Saade, Y. A., Lefebvre, A., Poncet, A., Rubin, S., & Biancari, F. (2019). Negative Pressure versus Conventional Sternal Wound Dressing in Coronary Surgery Using Bilateral Internal Mammary Artery Grafts. The Heart Surgery Forum, 22(2), E092-E096. https://doi.org/10.1532/hsf.2269

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