• Mario Gaudino, Katia Audisio, Mohamed Rahouma, N Bryce Robinson, Giovanni J Soletti, Gianmarco Cancelli, Ruth M Masterson Creber, Alastair Gray, Belinda Lees, Stephen Gerry, Umberto Benedetto, Marcus Flather, David P Taggart, and Arterial Revascularization Trial Investigators.
• Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY. Electronic address: mfg9004@med.cornell.edu.
• J. Thorac. Cardiovasc. Surg. 2023 Aug 1; 166 (2): 532539.e4532-539.e4.

ObjectiveTo evaluate the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial.MethodsParticipants in the Arterial Revascularization Trial were stratified according to the occurrence of postoperative SWC. The primary outcome was all-cause mortality at long-term follow-up. The secondary outcome was major adverse cardiovascular events.ResultsThree thousand one hundred two patients were included in the analysis; the median follow-up was 10 years. 115 patients (3.7%) had postoperative SWC: 85 (73.9%) deep sternal wound infections and 30 (26.1%) sterile SWC that required sternal reconstruction. Independent predictors of SWC included diabetes (odds ratio [OR], 2.77; 95% CI, 1.79-4.30; P < .001), female sex (OR, 2.73; 95% CI, 1.71-4.38; P < .001), prior stroke (OR, 2.59; 95% CI, 1.12-5.98; P = .03), chronic obstructive pulmonary disease (OR, 2.44; 95% CI, 1.60-3.71; P < .001), and use of bilateral internal thoracic artery (OR, 1.70; 95% CI, 1.12-2.59; P = .01). Postoperative SWC was significantly associated with long-term mortality. The Kaplan-Meier survival estimate was 91.3% at 5 years and 79.4% at 10 years in patients without SWC, and 86.1% and 64.3% in patients with SWC (log rank P < .001). The rate of major adverse cardiovascular events was also higher among patients who had SWC (n = 51 [44.3%] vs 758 [25.4%]; P < .001). Using multivariable analysis, the occurrence of SWC was independently associated with long-term mortality (hazard ratio, 1.81; 95% CI, 1.30-2.54; P < .001).ConclusionsIn the Arterial Revascularization Trial, postoperative SWC although uncommon were significantly associated with long-term mortality.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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