Objective: Changing risk profiles have led to increased portion of female patients referred to coronary artery bypass grafting. Concomitant female gender and high body mass index (BMI) greater than 30 kg /m2 has been repeatedly delineated as independent predictor for deep sternal wound infection (DSWI) following bilateral internal thoracic artery (BITA), increasing this risk by multiple-fold. The choice of BITA grafting in young obese female patients subsequently remains undetermined.
Methods: The data of 110 consecutive female patients undergoing BITA grafting (2006-2011) were evaluated. Subgroup analysis was performed according to BMI greater (group I) or lower (group II) than 30 kg/m2.
Results: Group I comprised 48% (n=53). Mean age was 62.52± 3 and 63.24± 4 years in group I and II, respectively, p=0.66. Group I patients 65 years or younger comprised 49%. The overall incidence of DSWI was 4.5% (5/110); 5.7% (n=3) and 3.7% (n=2) in groups I and II, respectively (p=0.72). Sternoplasty was performed in 1.8% (n=2); all in group I (3.7% vs 0%, p=0.16). The remaining two patients achieved resolution by vaccum-assisted drainage. Nevertheless, 60% (n=3) of DSWI and all sternoplasties were confined to the first 2 years of the study (2006-2007). The incidence of DSWI during the last 4 years (2008-2011) was 2.6%; all treated non-surgically. DSWI-related mortality was not documented in either group irrespective of study-period.
Conclusions: In female patients undergoing BITA grafting the risk of DSWI is higher in subsets with BMI greater than 30 kg/m2. However, ongoing tendency towards reduced incidence, effective non-surgical treatment and mitigation of DSWI-related mortality suggest that use of BITA in young obese female patients may be considered in attempt to enhance long-term survival.
