Skeletonized vs. Pedicled LIMA in Diabetic Patients Undergoing CABG: A Meta-Analysis

Abstract The left internal mammary artery (LIMA) remains the preferred conduit for coronary artery bypass grafting (CABG). However, diabetic patients face an increased risk of deep sternal wound infection (DSWI), particularly after pedicled LIMA harvesting, which may impair sternal perfusion. Skeletonized harvesting preserves sternal vascularity and may reduce infection risk, but current evidence remains limited and inconsistent. Three different databases were assessed. The primary outcome was the occurrence of DSWI. Secondary outcomes were hospital length of stay (LOS), cardiopulmonary bypass (CPB) time, blood transfusion rates, and aortic cross-clamp time. A random effects model was performed. Three retrospective studies involving 400 diabetic patients were included, of whom 190 underwent skeletonized and 210 pedicled LIMA harvesting. Skeletonized harvesting was associated with significantly reduced risk of DSWI (odds ratio OR: 0.25; 95% confidence interval CI: 0.07–0.88; p = 0.031). CPB (mean difference MD: 3.03 minutes; 95% CI: 1.18–4.88; p = 0.001) and aortic cross-clamp times (MD: 3.06 minutes; 95% CI: 2.03–4.10; p < 0.001) were slightly longer in the skeletonized group. No significant differences were observed in hospital LOS (p = 0.159) or blood transfusion requirements (p = 0.959). Skeletonized LIMA harvesting is associated with lower odds of DSWI in diabetic patients undergoing CABG, despite modestly longer operative times.