Cor Vasa 2010, 52(5-6):318-324 | DOI: 10.33678/cor.2010.083

Is diabetes mellitus a significant predictor of impaired sternotomy healing when using two skeletonized and harvested internal thoracic arteries?

Andrea Steriovský^1,*, Vilém Bruk¹, Jana Vrbková², Marek Gwozdziewicz¹, Martin Šimek¹, Petr Šantavý¹, Martin Kaláb¹, Martin Troubil¹, Ivo Fluger¹, Vladimír Lonský¹

¹ Kardiochirurgická klinika, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého, Olomouc

² Katedra matematické analýzy a aplikací matematiky, Přírodovědecká fakulta Univerzity Palackého Olomouc, Olomouc, Česká republika

Aim: To assess the extent to which diabetes mellitus affects sternotomy healing in patients undergoing myocardial revascularization procedures performed with two skeletonized and harvested internal thoracic arteries.

Methods: Data of a series of 300 consecutive patients with coronary heart disease undergoing elective myocardial revascularization procedures were analyzed retrospectively. Entry criteria included age of 70 years or below, left ventricular ejection fraction over 40%, and a hemodynamically significant stenosis in the vascular bed of both left coronary artery branches. Group A consisted of 150 patients with skeletonization of both internal thoracic arteries (ITA) without surrounding tissue, Group B was made up of 150 patients with a single ITA harvested as a pedicle with surrounding tissue. The median age of patients in Groups A and B was 59 and 64 years, respectively. All patients were followed up to detect impaired sternotomy healing, should it occur, assessed with the following scale: 0 - healed per primam, 1 - impaired soft tissue healing, 2 - deep sternal infection, combined with identification of potential risk factors, placing special emphasis on diabetes mellitus (DM). The effect of individual markers as predictors of postoperative complications was analyzed using multinomic logistic regression.

Results: Groups A and B included 37 and 77 patients with DM, respectively. Analysis of data of the whole group of 300 surgical patients did not identify DM, as opposed to age, as a significant predictor of impaired sternotomy healing. The point estimate of odds ratio (OR) was 1.044, with its 95% confidence interval (CI) being 1.037-1.052. The type of surgery was likewise not identified as a major predictor.
In models analyzing either group separately, DM and age were not found to be significant predictors. While analysis in Group A revealed hyperlipidemia as the only significant predictor, with OR = 4.971 (95% CI 1.228-20.124), no such predictor was identified in Group B.

Conclusion: Our results indicate that, in patients with skeletonized harvest of both internal thoracic arteries, diabetes mellitus is not a significant predictor of impaired sternotomy healing.

Keywords: Internal thoracic artery; Diabetes mellitus; Impaired sternotomy healing

Published: May 1, 2010  Show citation