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Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients
Takashi Hirotani1, Tsukasa Nakamichi, Mamoru Munakata
1Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, Minato-Ku, Tokyo, Japan. hero.takashi@nifty.ne.jp
Insights
Bilateral internal thoracic artery (ITA) grafting is safe and effective for diabetic patients undergoing coronary artery bypass grafting (CABG). This study found no significant difference in mortality or long-term outcomes between unilateral and bilateral ITA grafts in diabetics.
Area of Science:
- Cardiovascular Surgery
- Diabetic Medicine
- Thoracic Surgery
Background:
- Traditionally, bilateral internal thoracic artery (ITA) grafting has been avoided in diabetic patients undergoing coronary artery bypass grafting (CABG).
- Recent clinical perspectives suggest that diabetes should not preclude the use of bilateral ITAs.
- This study aimed to compare outcomes of unilateral versus bilateral ITA grafting in diabetic patients.
Purpose of the Study:
- To evaluate the safety and efficacy of bilateral ITA grafting in diabetic patients.
- To compare early and long-term results of unilateral and bilateral ITA grafts in diabetic CABG patients.
- To determine if diabetes or insulin use impacts outcomes with bilateral ITA grafting.
Main Methods:
- A retrospective review of 303 consecutive diabetic patients who underwent CABG using ITA grafts between April 1991 and January 2003.
- Patients were divided into two groups: 179 receiving bilateral ITA grafts and 124 receiving unilateral ITA grafts.
- Insulin use was analyzed as a factor affecting outcomes.
Main Results:
- Operative mortality was similar for both groups (1.7% for bilateral vs. 1.6% for unilateral).
- Insulin use did not significantly affect CABG mortality.
- No differences in morbidity were observed between the groups.
- Long-term survival, cardiac-death-free, and cardiac-event-free survival curves showed no difference between unilateral and bilateral ITA use in diabetics.
- Bilateral ITA grafting showed superior results compared to unilateral grafting in a comparable group of non-diabetic patients.
Conclusions:
- Single versus double ITA grafting in diabetic patients showed no significant difference in operative mortality.
- Long-term follow-up revealed no significant difference between the use of one or two ITA grafts in diabetic patients.
- Bilateral ITA grafting is a safe and effective option for diabetic patients undergoing CABG.
Background:
There is a tendency to avoid the bilateral internal thoracic artery (ITA) grafting in diabetics. However, we no longer consider diabetes a reason for excluding the bilateral use of ITAs. We compare the early and long-term results in diabetic cases treated by coronary artery bypass grafting (CABG) using unilateral and bilateral ITA grafts.
Methods:
A total of 303 consecutive diabetic cases of CABG using ITA grafts between April 1991 and January 2003 were reviewed. Of these, 149 (49%) were being treated with insulin. The cases were divided into two groups: 179 cases in which bilateral ITA grafts had been used and 124 in which a unilateral ITA graft had been used.
Results:
The mortality for the bilateral ITA group and unilateral ITA group were 1.7% and 1.6%, respectively. The fact that patients were receiving insulin had no effect on the mortality of CABG. A review of morbidity revealed that no differences were found between the two groups. The survival curves, cardiac-death-free curves, and cardiac-event-free curves showed that there was no difference between the use of one or two ITA grafts in diabetics, while bilateral use of ITA grafts was significantly better than unilateral use in a comparable group of nondiabetics operated during the same time period.
Conclusions:
There was no significant difference in operative mortality related to single or double ITA grafting in diabetics. There was also no difference between the use of one or two ITA grafts in diabetics in regard to long-term follow-up.
