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Routine use of bilateral skeletonized internal thoracic artery grafts in middle-aged diabetic patients
Olivier M Bical1, Wassim Khoury, Yves Fromes
1Department of Cardiac Surgery, Fondation Hopital Saint Joseph, Paris, France. ombical@hopital-saint-joseph.org
Insights
Routine bilateral internal thoracic artery grafting is safe for middle-aged diabetic patients under 70. The skeletonized technique may reduce deep wound infections in this patient group.
Area of Science:
- Cardiovascular Surgery
- Diabetic Patient Management
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Internal thoracic artery (ITA) grafting offers superior long-term patency rates.
- The safety of bilateral ITA grafting in diabetic patients requires further investigation.
Purpose of the Study:
- To assess the safety and outcomes of routine bilateral skeletonized internal thoracic artery (ITA) grafting in diabetic patients under 70 years old.
- To compare the surgical risk of diabetic patients undergoing bilateral ITA grafting with non-diabetic patients.
Main Methods:
- A retrospective analysis of 712 patients under 70 who underwent bilateral ITA grafting between 1997 and 2003.
- Comparison of postoperative outcomes between 164 nonselected diabetic patients and 548 non-diabetic patients.
Main Results:
- Operative mortality was similar between diabetic (4.3%) and non-diabetic (2.4%) groups (p=NS).
- Deep sternal wound infection rates were comparable (1.1% vs 1.2%, p=NS).
- Diabetic patients showed a higher incidence of renal failure without dialysis (6.7% vs 2.0%, p<0.01).
Conclusions:
- Routine bilateral skeletonized ITA grafting can be safely performed in nonselected middle-aged diabetic patients.
- The skeletonized ITA harvesting technique may contribute to low deep wound infection rates.
- While overall morbidity is similar, careful monitoring for renal complications in diabetic patients is warranted.
Background:
The purpose of this study was to determine whether middle-aged diabetic patients aged less than 70 years could have routine use of bilateral skeletonized internal thoracic artery grafting without an increased surgical risk.
Methods:
Between January 1997 and December 2003, 712 consecutive patients aged less than 70 years underwent bilateral internal thoracic artery grafting. Among these, 164 were diabetic and underwent bilateral internal thoracic artery grafting without other preoperative selection than age. The postoperative results of these 164 nonselected consecutive diabetic patients were compared to these of the 548 nondiabetic patients.
Results:
The operative mortality rate was 4.3% (7 patients) in the diabetic group and 2.4% (13 patients) in the nondiabetic group (p = not significant [NS]). Deep sternal wound infection was observed in 2 patients (1.1%) in the diabetic group and in 6 patients (1.2%) in the nondiabetic group (p = NS). There were no significant difference in the morbidity rate between the two groups except for renal failure without dialysis (6.7% in the diabetic group vs 2.0% in the nondiabetic group, p < 0.01).
Conclusions:
Routine use of bilateral internal thoracic artery grafting was performed in nonselected middle-aged diabetic patients without increased morbidity. The low rate of deep wound infections could be related to the skeletonized technique of internal thoracic artery harvesting.
