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Optimal conduit for diabetic patients: propensity analysis of radial and right internal thoracic arteries

Darryl M Hoffman1, Kamellia R Dimitrova1, David J Lucido2

  • 1Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.

The Annals of Thoracic Surgery
|June 1, 2014
PubMed

Insights

For diabetic patients undergoing coronary artery bypass grafting (CABG), the radial artery (RA) conduit showed similar long-term survival compared to the right internal thoracic artery (RITA). RA grafts resulted in fewer adverse events, making them a preferred choice for multiple arterial grafting.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Grafting
  • Diabetic Patient Care

Background:

  • Multiple arterial grafts improve long-term survival in coronary artery bypass grafting (CABG).
  • Use of the right internal thoracic artery (RITA) and radial artery (RA) remains suboptimal.
  • Optimal arterial conduit choice for diabetic patients needs further investigation.

Purpose of the Study:

  • To compare the outcomes of radial artery (RA) versus right internal thoracic artery (RITA) grafts in diabetic patients undergoing coronary artery bypass grafting (CABG).
  • To identify the preferred arterial conduit for revascularization in diabetic patients.

Main Methods:

  • Prospective data collection from 908 diabetic patients undergoing isolated CABG between 1995 and 2011.
  • Comparison of RA (659 patients) and RITA (502 patients) grafts to the circumflex coronary artery.
  • Propensity matching identified 202 pairs for analysis of late mortality and adverse events.

Main Results:

  • Long-term survival was similar between RA and RITA graft groups.
  • No significant differences in mortality, myocardial infarction, reoperation for bleeding, stroke, sepsis, or renal failure.
  • Radial artery grafts were associated with significantly fewer deep sternal wound infections and respiratory failures, leading to fewer total major adverse events.

Conclusions:

  • Radial artery (RA) and right internal thoracic artery (RITA) grafts offer similar long-term survival in diabetic patients undergoing multivessel revascularization.
  • RA grafts are associated with a lower incidence of respiratory and sternal wound complications.
  • The RA is the preferred arterial conduit for extending the benefits of multiple arterial grafting strategies to diabetic patients.
Abstract

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