Bilateral internal thoracic artery grafting in insulin-treated diabetes

• Published in: Asian cardiovascular & thoracic annals Vol. 21; no. 6; pp. 661 - 668
• Main Authors: Lev-Ran, Oren, Matsa, Menachem, Ishay, Yaron, Abod, Moataz Abo, Vodonos, Alina, Sahar, Gideon
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.12.2013
• Subjects: Aged; Biomarkers - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - mortality; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - mortality; Diabetic Angiopathies - surgery; Disease-Free Survival; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Internal Mammary-Coronary Artery Anastomosis - adverse effects; Internal Mammary-Coronary Artery Anastomosis - mortality; Kaplan-Meier Estimate; Male; Middle Aged; Patient Selection; Proportional Hazards Models; Radial Artery - transplantation; Retrospective Studies; Risk Assessment; Risk Factors; Surgical Wound Infection - etiology; Time Factors; Treatment Outcome; mammary arteries; diabetes mellitus; glycosylated; Coronary artery bypass; hemoglobin A; treatment outcome
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/0218492312466251

Background We sought to assess the risk and late outcome of bilateral internal thoracic artery grafting in eligible insulin-treated diabetic subsets. Methods 147 insulin-treated diabetic patients undergoing arterial revascularization were grouped as: skeletonized bilateral internal thoracic artery (n = 83) or internal thoracic artery-radial artery (n = 64). Chronic lung disease or overweight and female constituted exclusion criteria for bilateral internal thoracic artery grafts. Results Patients who had bilateral internal thoracic artery grafts were younger and comprised fewer females. Left-sided bilateral internal thoracic artery configurations were predominantly applied. Despite mean hemoglobin A1c of 8.0% ± 1% (range, 7%–13.5%) respective rates of deep sternal infection in bilateral internal thoracic artery and radial artery patients were 1.2% and 0%; superficial wound infection occurred in 3.1% and 3.6%, respectively. One sternoplasty was performed. Bilateral internal thoracic artery grafting did not correlate with sternal complications (odds ratio = 2.24, 95%CI: 0.56–8.95, p = 0.256). Of the radial artery conduits, 98% were adequate, and procurement-site complications occurred in 3.1%. Follow-up was 2–58 months (median, 25 months). Five-year survival was comparable in the 2 groups (p = 0.360). Bilateral internal thoracic artery grafting did not reduce late major adverse cardiac events (p = 0.729) or late mortality (p = 0.384). Conclusions Skeletonized bilateral internal thoracic artery grafts can be used with acceptable risk in a substantial portion of insulin-treated diabetic patients, so it should not be automatically denied, but the choice of such grafts is not associated with midterm cardiac benefits.