Polish Journal of Thoracic and Cardiovascular Surgery
eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
1/2026
vol. 23
 
Share:
Share:
Original paper

Impact of topical vancomycin paste on prevention of deep sternal wound infection in patients undergoing bilateral internal thoracic artery coronary bypass grafting

Sleiman Sebastian Aboul-Hassan
1, 2, 3
,
Tomasz Stankowski
4
,
Tomasz Urbanowicz
5
,
Maciej Luczak
6
,
Maria Luszczyn
1, 2
,
Lukasz Moskal
1
,
Marcin Nawotka
1
,
Maciej Peksa
1
,
Ryszard Stanislawski
1
,
Siarhei Amelchanka
1
,
Bartlomiej Perek
5
,
Marek Jemielity
5
,
Diana Nikola Matkowska
4
,
Miroslaw Brykczynski
1, 2
,
Pawel Bugajski
6, 7
,
Dirk Fritzsche
4
,
Romuald Cichon
1, 2, 3

  1. Department of Cardiac Surgery, Zbigniew Religa Heart Center “Medinet”, Nowa Sol, Poland
  2. Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland
  3. Department of Cardiac Surgery, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
  4. Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
  5. Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
  6. Department of Cardiac Surgery, J. Strus Hospital, Poznan, Poland
  7. Faculty of Health Sciences, University of Medical Sciences, Poznan, Poland
Kardiochirurgia i Torakochirurgia Polska 2026; 23 (1): 24–30
Online publish date: 2026/04/04
Article file
Get citation
 
PlumX metrics:
 
1. Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg 2016; 152: 962-972.
2. Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, Sousa-Uva M, Licht PB, Dunning J, Schmid RA, Cardillo G. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg 2017; 51: 10-29.
3. Loop FD, Lytle BW, Cosgrove DM, Mahfood S, McHenry MC, Goormastic M,Stewart RW, Golding LA, Taylor PC. Sternal wound complications after isolated coronary artery bypass grafting. Ann Thorac Surg 1990; 49: 179-186.
4. Ridderstolpe L, Gill H, Ahlfeldt H, Hallhagen S, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001; 20: 1168-1175.
5. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996; 61: 1030-1036.
6. Gårdlund B. Postoperative mediastinitis in cardiac surgery – microbiology and pathogenesis. Eur J Cardiothorac Surg 2006; 30: 898-905.
7. Diez C, Koch D, Kuss O. Risk factors for deep sternal wound infection after cardiac surgery – a retrospective cohort study. J Cardiothorac Surg 2007; 2: 118.
8. Söderquist B. Surgical site infections after cardiac surgery: epidemiology and prevention. Curr Opin Infect Dis 2007; 20: 337-342.
9. Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, Adams DH. Epidemiology of deep sternal wound infection. J Cardiothorac Vasc Anesth 2009; 23: 488-494.
10. Schimmer C, Reents W, Berneder S. Prevention of deep sternal wound infection. Eur J Cardiothorac Surg 2008; 33: 593-597.
11. Matros E, Aranki SF, Bayer LR, Orgill DP. Reduction in sternal wound infections after cardiac surgery. Ann Plast Surg 2016; 76: S222-S225.
12. Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg 2004; 78: 2005-2012.
13. Locker C, Schaff HV, Dearani JA, Joyce LD,  Park SJ, Burkhart HM, Suri RM,Greason KL, Stulak JM, Li Z, Daly RC. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation 2012; 126: 1023-1030.
14. Benedetto U, Amrani M, Gaer J, Bahrami T, de Robertis F, Simon AR, Raja SG;Harefield Cardiac Outcomes Research Group. The influence of bilateral internal mammary arteries on short- and long-term outcomes: a propensity score matching in accordance with current recommendations. J Thorac Cardiovasc Surg 2014; 148: 2699-2705.
15. Schwann TA, Hashim SW, Badour S, Obeid M, Engoren M, Tranbaugh RF,Bonnell MR, Habib RH. Equipoise between radial artery and right internal thoracic artery as the second arterial conduit in left internal thoracic artery-based coronary artery bypass graft surgery: a multi-institutional study. Eur J Cardiothorac Surg 2016; 49: 188-195.
16. Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C, Saint-Hilary G, Leonard J, Iannaccone M, D’Ascenzo F, Di Franco A, Soletti G, Kamel MK, Lau C, Girardi LN, Schwann TA, Benedetto U, Taggart DP, Fremes SE.Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: a network meta-analysis of clinical outcomes. J Am Heart Assoc 2019; 8: e010839.
17. Chikwe J, Sun E, Hannan EL, Itagaki S, Lee T, Adams DH, Egorova NN. Outcomes of second arterial conduits in patients undergoing multivessel coronary artery bypass graft surgery. J Am Coll Cardiol 2019; 74: 2238-2248.
18. Aboul-Hassan SS, Marczak J, Stankowski T, Moskal L, Stanislawski R, Perek B, Cichon R. Impact of second arterial conduit on outcomes following coronary bypass gr afting. Thorac Cardiovasc Surg 2023; 71: 434-440.
19. Aboul-Hassan SS, Hirnle G, Perek B, Jemielity M, Hirnle T, Brykczynski M, Deja M, Rogowski J, Cisowski M, Krejca M, Anisimowicz L, Widenka K, Gerber W,  Pacholewicz J, Bugajski P, Stepinski P, Maruszewski BJ, Cichon R, Hrapkowicz T; KROK Investigators. Single versus multiple arterial coronary artery bypass grafting in men and women: results from Polish National Registry of Cardiac Surgery Procedures. Int J Surg 2024; 110: 2234-2242.
20. Gaudino M, Chikwe J, Falk V, Lawton JS, Puskas JD, Taggart DP. Transatlantic editorial: the use of multiple arterial grafts for coronary revascularization in Europe and North America. Eur J Cardiothorac Surg 2020; 57: 1032-1037.
21. Kowalewski M, Pasierski M, Makhoul M, Comanici M, D¹browski EJ, Matteucci M, Litwinowicz R, Kowalówka A, Wañha W, Jiritano F, Fina D, Martucci G, Raffa GM, Malvindi PG, Kuźma £, Suwalski P, Lorusso R, Meani P, Lazar H; Thoracic Research Centre. Topical vancomycin for sternal wound infection prophylaxis. A systematic review and updated meta-analysis of over 40,000 cardiac surgery patients. Surgery 2023; 174: 1102-1112.
22. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC,  Mulrow CD, Pocock SJ, Poole C,  Schlesselman JJ, Egger M; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014; 12: 1500-1524.
23. Austin PC. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J Thorac Cardiovasc Surg 2007; 134: 1128-1135.
24. Benedetto U, Head SJ, Angelini GD, Blackstone EH. Statistical primer: propensity score matching and its alternatives. Eur J Cardiothorac Surg 2018; 53: 1112-1117.
25. Austin PC. Optimal caliper widths for propensity‐score matching when estimating differences in means and differences in proportions in observational studies. Pharmaceut Statist 2011; 10: 150-161.
26. Austin PC. Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol 2010; 172: 1092-1097.
27. Austin PC. A tutorial and case study in propensity score analysis: an application to estimate the effect of in-hospital smoking cessation counseling on mortality. Multivariate Behav Res 2011; 46: 119-151.
28. Collins GS, Le Manach Y. Comparing treatment effects between propensity scores and randomized controlled trials: improving conduct and reporting. Eur Heart J 2012; 33: 1867-1869.
29. VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med 2017; 167: 268-274.
30. Gaster T, Eggertsen CM, Støvring H, Ehrenstein V, Petersen I. Quantifying the impact of unmeasured confounding in observational studies with the E value. BMJ Med 2023; 2: e000366.
31. Chung WT, Chung KC. The use of the E-value for sensitivity analysis. J Clin Epidemiol 2023; 163: 92-94.
32. Haneuse S, VanderWeele TJ, Arterburn D. Using the E-value to assess the potential effect of unmeasured confounding in observational studies. JAMA 2019; 321: 602-603.
33. Gaudino M, Audisio K, Rahouma M, Robinson NB, Soletti GJ, Cancelli G, Masterson Creber RM, Gray A, Lees B, Gerry S, Benedetto U, Flather M, Taggart DP; Arterial Revascularization Trial Investigators. Association between sternal wound complications and 10-year mortality following coronary artery bypass grafting. J Thorac Cardiovasc Surg 2023; 166: 532-539.
34. Phoon PHY, Hwang NC. Deep sternal wound infection: diagnosis, treatment and prevention. J Cardiothorac Vasc Anesth 2020; 34: 1602-1613.
35. Li M, Yu Z, Chen Q, Zhao Q, Chen X, Lei C, Wang X, Yang R. Sternal wound infections following internal mammary artery grafts for a coronary bypass: a meta-analysis. Int Wound J 2024; 21: e14349.
36. Aboul-Hassan SS, Hirnle G, Perek B, Jemielity M, Kocanda S, Hirnle T, Brykczynski M, Gocol R, Deja M, Rogowski J, Krejca M, Pawliszak W, Widenka K, Pacholewicz J, Bugajski P, Wrobel K,  Maruszewski BJ, Hrapkowicz T, Cichon R; KROK Investigators. Impact of deep sternal wound infection on long-term survival based on revascularisation strategy: results from the Polish National Registry. Heart Lung Circ 2025; 34: 961-968.
37. Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R. Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg 2006; 30: 898-905.
38. Sommerstein R, Atkinson A, Kuster SP, Thurneysen M, Genoni M, Troillet N, Marschall J,  Widmer AF; Swissnoso. Antimicrobial prophylaxis and the prevention of surgical site infection in cardiac surgery: an analysis of 21 007 patients in Switzerland. Eur J Cardiothorac Surg 2019; 56: 800-806.
39. Boodhwani M, Lam BK, Nathan HJ, Mesana TG, Ruel M, Zeng W, Sellke FW, Rubens FD. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blind, within-patient comparison. Circulation 2006; 114: 766-773.
40. Dimagli A, Gemelli M, Kumar N, Mitra M, Sinha S, Fudulu D, Harik L, Cancelli G, Soletti Jr G, Perezgrovas Olaria R, Bonaros N, Gaudino M, Angelini GD. A systematic review and meta-analysis of internal thoracic artery harvesting techniques: skeletonized vs pedicled. Int J Cardiol 2024; 395: 131577.
41. Iino K, Yoshioka K, Iba T, Ito Y, Sakai A, Harlyjoy BC, Yamamoto Y, Ando H, Naito H, Takemura H. The harvesting technique affects the production of nitric oxide and endothelin in the internal thoracic artery graft. J Thorac Cardiovasc Surg 2026: 171: 640-648.
42. Mastrobuoni S, Gawad N, Price J, Chan V, Ruel M, Mesana TG, Rubens FD. Use of bilateral internal thoracic artery during coronary artery bypass graft surgery in Canada: the bilateral internal thoracic artery survey. J Thorac Cardiovasc Surg 2012; 144: 874-879.
43. Velez AK, Alejo D, Holmes SD, Fonner CE, Clement KC, Whitman GJ, Salenger R, Ad N, Lawton JS. Multiple arterial graft use in coronary artery bypass surgery: surgeon perspective vs practice. Ann Thorac Surg 2023; 116: 474-481.
Copyright: © 2026 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2026 Termedia Sp. z o.o.
Developed by Termedia.