TITLE:
Comparison of Sternal Wound Complication after Off-Pump CABG between Skeletonized and Pedicled LIMA Harvesting: A Single Centre Experience in Bangladesh
AUTHORS:
M. Asmaul Alam Al Nur, Md. Aslam Hossain, Md. Abir Tazim Chowdhury, Farhat Tabassum Nishat, Munama Magdum
KEYWORDS:
Sternal Wound Complication (SWC), Off-Pump Coronary Artery Bypass Grafting (OPCAB), Left Internal Mammary Artery (LIMA), Skeletonized LIMA Harvesting, Pedicle LIMA Harvesting
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.6,
June
21,
2023
ABSTRACT: Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure
that has gained popularity due to its potential benefits over traditional
coronary artery bypass grafting, including reduced morbidity and mortality.
However, sternal wound complication (SWC) remains challenging following the
procedure. The technique of left internal mammary artery (LIMA) harvesting has
been shown to impact the incidence of SWC. This study aimed to compare the
incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu
Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB.
The patients were divided into two groups of 30 each based on the technique of
LIMA harvesting used, i.e.,
skeletonized (group A) or pedicled (group B). The postoperative ICU care was
given to each patient as per the protocol. The statistical analysis was
conducted using the SPSS version 26.0 for Windows software. Results: The
results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in
group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was
not statistically significant between the two groups (p = 0.35).
The mean age, gender distribution, and comorbidities such as hypertension, diabetes,
dyslipidemia, and anemia were also not statistically significant between the
two groups. The number of smokers was statistically significant between the two
groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker
patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of
operation, duration of mechanical ventilation, duration of chest drains,
duration of the central venous line, and amount of postoperative mediastinal
bleeding were also not statistically
significant between the two groups. The distribution of wound
complications, duration of ICU stays, and hospital stay between the two groups
was also not statistically significant. Conclusion: In conclusion, this
study found that the incidence of SWC was less in skeletonized LIMA harvesting
than in pedicled LIMA harvesting after OPCAB. However, this finding was not
statistically significant. Further studies with larger sample sizes may be
needed to confirm these results and determine the appropriate technique of LIMA
harvesting to decrease the incidence of SWC after OPCAB.