[Arterial grafts in coronary surgery for diabetic patients]

Area of Science:

• Cardiovascular Surgery
• Diabetic Medicine
• Vascular Biology

Context:

• Coronary multi-vessel disease in diabetic patients presents unique challenges for revascularization strategies.
• Percutaneous coronary interventions may offer less favorable long-term outcomes compared to surgical revascularization in this population.
• The optimal choice of arterial conduits for coronary artery bypass grafting in diabetics remains an area of active investigation.

Purpose:

• To systematically analyze the current literature on the use of arterial grafts in diabetic patients undergoing coronary revascularization.
• To compare the long-term efficacy and safety of radial artery versus internal mammary artery grafts in diabetic patients.
• To evaluate the impact of bilateral internal mammary artery grafting on survival and complications in diabetic individuals.

Summary:

• Diabetic patients with multi-vessel coronary disease experience superior long-term outcomes with surgical revascularization over percutaneous coronary interventions.
• The radial artery demonstrates a higher propensity for atherosclerosis in diabetics compared to the internal mammary artery.
• Bilateral internal mammary artery grafts are associated with better long-term survival in diabetic patients, without an obligatory increase in thoracic wound infections.

Impact:

• Diabetic patients should benefit from the utilization of a second internal mammary artery graft for coronary revascularization.
• A second internal mammary artery graft appears to be a more favorable conduit choice than a radial artery graft in diabetic patients, considering long-term patency and disease progression.
• These findings support the expanded use of bilateral internal mammary artery grafts in diabetic patients to improve long-term cardiac health and survival.