Bilateral internal thoracic artery grafting in diabetic patients: perioperative risk analysis

Diabetic patients have a higher risk to acquire coronary artery disease at younger ages and vein grafts used in these patients have a tendency to develop stenosis earlier. No significant differences have been reported between the patency of internal thoracic artery (ITA) grafts in diabetic and non-diabetic patients. However, bilateral ITA grafting in diabetic patients remains a controversial topic due to increased risks in the perioperative morbidity.

The effects of bilateral ITA grafting on perioperative morbidity for diabetic patients were studied in two different trials. The first study compared 25 diabetic patients with 25 non-diabetic patients with bilateral ITA grafts for the length of the intensive care unit and hospital stay periods, for superficial wound infection, sternal dehiscence, mediastinitis rates and readmissions following discharge. The second study compared 30 diabetic patients with bilateral ITA grafts to 30 diabetic patients with unilateral ITA grafts for the same criteria as in the first study.

The first study showed no statistical difference between diabetic and non-diabetic patients for the criteria studied, but a slight increase was clinically observed in the readmission rate for diabetic patients due to superficial wound infection. The second study showed neither statistical, nor clinical differences between the two groups.

Full arterial revascularization is very important for the prognosis of diabetic patients. With a careful management, the slight increase in the perioperative morbidity could be reduced to acceptable levels enabling the diabetic patients to benefit from the long-term advantages of bilateral ITA grafting.