Risk of sternal wound infection in bilateral skeletonized internal thoracic artery in coronary artery bypass grafting: a propensity score matching analysis

Abstract Background A growing body of evidence shows that choosing an arterial graft as a second graft for coronary artery bypass grafting (CABG), has a superior patency and a survival benefit when compared to a saphenous vein graft (SVG). However, surgeons are wary to utilize the right internal mammary artery (RIMA), because of concerns of sternal wound infections (SWI). This study aims to evaluate the risk of SWI in bilateral internal mammary artery (BIMA) usage while performing skeletonized harvesting. Methods Between January 2020 and July 2023, 1785 consecutive patients suffering from coronary artery disease (CAD) underwent a CABG operation at our hospital. Propensity score matching was performed where 259 single internal mammary artery (SIMA) patients were compared to 259 BIMA patients. We assessed sternal wound infections, and performed univariate and multivariate analysis identifying risk factors for SWI. Results There were six (1.2%) wound infections, evenly divided between SIMA ( n = 3, 1.2%) and BIMA ( n = 3, 1.2%) groups. Multivariate testing showed female gender (OR: 3.21, 95%CI: 1.58–6.55, p = 0.001), diabetes (OR: 3.07, 95%CI: 1.42–6.61, p = 0.004, NYHA class ≥ 3 (OR: 2.38, 95%CI: 1.09–5.20, p = 0.029) and postoperative delirium (OR: 1.92, 95%CI: 1.29–2.85, p = 0.001) to be significant risk factors for SWI. BIMA grafting was not confirmed as an independent risk factor for SWI (OR: 0.66, 95%CI: 0.19–2.27, p = 0.506). Conclusion This study shows that skeletonized BIMA grafting does not increase the risk of SWI. Female gender, diabetes, NYHA ≥ 3 and postoperative delirium did increase the risk for a sternal wound infection.