Sternal Closure with Rigid Plate Fixation for Isolated Coronary Artery Bypass Grafting: Can Sternal Plating Increase the Feasibility of Bilateral Internal Thoracic Artery Usage in High-Risk Patients?

Objectives Long-term survival after coronary artery bypass grafting (CABG) appears superior with bilateral internal thoracic artery (BITA) grafting over grafting a single internal thoracic artery. BITA grafting is recommended in CABG without excessive risk of infection. However, there is concern about an increased risk of sternal wound infection when BITAs are harvested. A recent report demonstrated that sternal closure with rigid plate fixation provided better sternal healing and fewer complications. Thus, a retrospective study was performed to investigate whether BITA grafting can be safely performed in CABG with rigid plate fixation for patients at high risk of sternal wound infection. Methods From June 2017 to December 2018, a total of 31 patients who were deemed preoperatively to be at high risk of sternal wound infection underwent isolated CABG ± pulmonary vein isolation. BITAs were skeletonized, and the chest was closed with rigid plate fixation in all cases. The surgical results were retrospectively reviewed, and the incidence of sternal wound complications was evaluated. Results Each patient had at least 2 risk factors, and the average number of risk factors per patient was 3.1. A total of 14 patients (45%) had obesity, with mean BMI of 31 ± 8.1 kg/m , and 27 patients (86%) had diabetes mellitus, with mean HbA1c of 7.6 ± 1.5%. There was one patient with superficial sternal wound infection (3%) and one with wound dehiscence (3%); they were medically treated at the outpatient clinic without readmission. There was no incidence of deep sternal wound infection. Conclusions BITA grafting could be performed in high-risk patients without increasing sternal wound complications. Rigid sternal plating fixation may increase the feasibility of BITA grafting in high-risk patients.