On-Pump versus Off-Pump Complete Arterial Revascularization Using Bilateral Internal Mammary Arteries and the T-Graft Technique: Clinical and Angiographic Results for 3,445 Patients in 13 Years of Follow-Up.

BACKGROUND: This is an investigation of complete arterial coronary artery bypass grafting (CACABG) using bilateral internal mammary arteries (IMA) and the T-graft technique either on- or off-pump as a routine approach to treat coronary artery disease. METHODS: Between January 2000 and December 2012, 3,445 patients underwent on-pump (n = 2,216) or off-pump (n = 1,229) CACABG. A 30-day follow-up was performed prospectively, a long-term follow-up by a questionnaire, and coronary angiography in selected patients. RESULTS: End points at 30 days were death, myocardial infarction, stroke, repeat revascularization, renal replacement, reoperation, sternal wound infection and atrial fibrillation. FitzGibbon A patency rates were 89.8 vs. 91.4% (p = 0.464) with consecutive percutaneous coronary intervention in the grafted area of 1.8 vs. 1.1% (p = 0.693) on- vs. off-pump, and no reoperation in the grafted area in both groups. CONCLUSION: CACABG by use of skeletonized bilateral IMA with the T-graft technique performed either on- or off-pump is a safe and effective approach.

A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy.

BACKGROUND: Sternal dehiscence after full median sternotomy may result in wound-healing disorders, including osteomyelitis. The consequences are extended hospitalization, plastic surgery, stress for the patient, and increased costs. Stable closure of the median sternotomy plays a crucial role in the avoidance of sternal dehiscence and osteomyelitis. METHODS: All patients who underwent full sternotomy from January 1999 until December 2001 were investigated with respect to the incidence of sternal dehiscence. Since January 2000, patients supposed to be at risk for sternum dehiscence were more frequently treated with an Ethicon steel band at the third intercostal space in addition to standard osteosynthesis with 8 wire cerclages. RESULTS: Since the introduction of this method, the incidences of sternal dehiscence and sternal wound infections decreased from 2.9% and 0.9 %, respectively, in 1999 to 0.3% and 0.2%, respectively, in 2001. This decline resulted in shorter postoperative hospital stays, less stress for the patients, and substantial reductions in postsurgical costs. CONCLUSIONS: A steel band used in addition to standard osteosynthesis with 8 wire cerclages is a safe and effective procedure resulting in a statistically significant decrease in the frequency of sternal dehiscence.