Related Experiment Video
Updated: Aug 3, 2026
A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice
Published on: January 23, 2016
Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus
1Department of Thoracic and Cardiovascular Surgery, Tel-Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Bilateral skeletonized internal thoracic artery grafting is a safe option for diabetic patients, with comparable sternal infection rates to non-diabetics. Obese diabetic women, however, face a higher infection risk and may benefit from single artery grafting.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Thoracic Surgery
Background:
- Deep sternal infections historically limit bilateral internal thoracic artery (BITA) grafting in diabetic patients.
- Skeletonized harvesting technique for internal thoracic arteries may reduce infection risk.
- Diabetic patients often present with comorbidities like hypertension and heart failure, influencing surgical outcomes.
Purpose of the Study:
- To compare the outcomes of BITA grafting in diabetic versus nondiabetic patients.
- To evaluate the safety and efficacy of skeletonized BITA grafting in a diabetic population.
- To identify specific risk factors for adverse events in diabetic patients undergoing BITA grafting.
Main Methods:
- Prospective study comparing 231 diabetic and 534 nondiabetic patients undergoing skeletonized BITA grafting (May 1996-April 1998).
- Analysis of baseline characteristics, including age, sex, hypertension, heart failure, and prior myocardial infarction.
- Comparison of operative mortality, deep sternal infection rates, stroke incidence, and 3-year survival.
Main Results:
- Operative mortality and deep sternal infection rates were similar between diabetic (3% and 2.6%) and nondiabetic (2.6% and 1.7%) groups.
- Obese diabetic women had a significantly higher risk of deep sternal infection (15%) compared to other diabetic patients (1.4%).
- Diabetic patients experienced a higher incidence of stroke (3.5% vs 0.9%) and a trend towards lower 3-year survival (91.3% vs 94.7%).
Conclusions:
- Skeletonized BITA grafting is a viable revascularization strategy for diabetic patients, offering comparable sternal infection rates to nondiabetic individuals.
- Obese diabetic women represent a high-risk subgroup for sternal infection, warranting consideration for single artery grafting.
- While overall outcomes are favorable, careful patient selection and risk stratification are crucial for diabetic patients undergoing BITA grafting.
Objective:
Increased risk of deep sternal infections has prohibited routine bilateral internal thoracic artery grafting in diabetic patients. The technique for harvesting the skeletonized internal thoracic artery provides the potential to minimize this risk. The purpose of this study was to compare the outcome of bypass grafting with bilateral skeletonized internal thoracic arteries in diabetic and nondiabetic patients.
Methods:
From May 1996 to April 1998, 231 consecutive diabetic and 534 nondiabetic patients underwent bilateral skeletonized internal thoracic artery grafting. Mean age was 66 years. Compared with the nondiabetic group, the diabetic group comprised more women (29% vs 18%, P =.001), had a greater prevalence of hypertension (53% vs 44%, P =.019) and congestive heart failure (20% vs 14%, P =.016), but a lower prevalence of preoperative acute myocardial infarction (26% vs 34%, P =.027).
Results:
Operative mortality of diabetic patients was comparable with that of nondiabetic patients (3% vs 2.6%). The two groups also had similar occurrences of deep sternal infection (2.6% vs 1.7%, respectively, P =.40). Deep sternal infection was significantly more prevalent in obese, diabetic women (3/20 = 15%) than in diabetic patients without this combination of risk factors (3/211 = 1.4%, P <.0001) (odds ratio 11.1, confidence interval 2.1-59.4). Diabetic patients also had a higher incidence of stroke (3.5% vs 0.9%, P =.014). Three-year actuarial survival of diabetic patients was lower (91.3% vs 94.7%, P =.083).
Conclusions:
Bilateral skeletonized internal thoracic artery grafting is a good surgical revascularization option in diabetic patients. Operative mortality and prevalence of sternal infection are comparable with those of nondiabetic patients. However, the risk of sternal infection in obese diabetic women is high, and for them we advocate the use of a single artery instead of bilateral internal thoracic arteries.
