BIMA And Post-Operative Sternal Stabilisation to Reduce Wound Infections
Total Arterial Myocardial Revascularization with Bilateral Internal Mammary Arteries
Stuttgart Heart Center, Prof Dr. Albert presents a large cohort study
In this large cohort study, researchers investigated the effectiveness of total arterial myocardial revascularization using bilateral internal mammary arteries (BIMA) and the role of postoperative sternal stabilization in reducing wound infections.
The study aimed to compare the incidence of wound complications in patients who underwent BIMA grafting with and without the use of a thorax support vest, such as the Posthorax vest.
The findings of this retrospective study suggest that the early perioperative use of a thorax stabilization vest can significantly reduce the incidence of sternal wound complications and shorten the length of hospital stay when a wound infection does occur.
Background:
Total arterial myocardial revascularization using bilateral internal mammary arteries has shown improved outcomes in terms of mortality, long-term survival, and graft patency. It has become the standard technique according to recent guidelines. However, these patients may have a higher risk of developing sternal wound infections, especially if they are obese or have diabetes. One potential factor contributing to wound complications is early sternum instability.
Objective:
The objective of this study was to compare the incidence of wound infections and the length of hospital stay in patients who underwent total arterial myocardial revascularization with BIMA grafting, with and without the use of a thorax support vest.
Methods:
The study included 1613 patients who underwent total arterial myocardial revascularization with BIMA grafting via a median sternotomy between April 2015 and May 2017. From the second postoperative day, the Posthorax support vest was used as a thorax stabilization measure. These patients were compared with 1667 patients who underwent the same procedure without the use of the vest in the preceding 26 months. The primary endpoints were the incidence of wound infections, the timing of wound infections, and the number of wound revisions required until wound closure.
Results:
The demographic data of both groups were similar. The study found a significant advantage for the use of a thorax support vest in reducing the incidence of wound infections (P = 0.036) and shortening the length of hospital stay when a wound complication did occur (P = 0.018).
