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The Impact of Diabetes on Early Outcomes after Routine Bilateral Internal Thoracic Artery Grafting
Giuseppe Gatti1, Luca Dell'Angela2, Luca Maschietto1
1Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
Insights
Bilateral internal thoracic artery (BITA) grafting is safe for diabetic patients, showing no increase in early mortality despite higher complication rates. This cardiac surgery technique can be routinely performed in diabetic individuals.
Area of Science:
- Cardiovascular Surgery
- Diabetic Complications
- Surgical Outcomes
Background:
- Bilateral internal thoracic artery (BITA) grafting is limited in diabetic patients due to increased postoperative complication risks.
- This study reviews routine BITA grafting to assess diabetes' impact on early outcomes.
Purpose of the Study:
- To investigate the impact of diabetes on early outcomes following bilateral internal thoracic artery (BITA) grafting.
- To compare postoperative complications and mortality between diabetic and non-diabetic patients undergoing BITA grafting.
Main Methods:
- Retrospective review of 4508 coronary bypass surgery patients from 1999-2015.
- Skeletonized BITA grafts used in 3228 patients (972 diabetic, 2256 non-diabetic).
- Propensity score-matched analysis of 819 diabetic/non-diabetic pairs, comparing outcomes using EuroSCORE II for risk assessment.
Main Results:
- Diabetic patients had higher baseline risk profiles (EuroSCORE II) in both unmatched and matched cohorts.
- No significant difference in hospital mortality between diabetic and non-diabetic groups (2.1% vs. 2.3%, p=0.74 in matched pairs).
- Diabetic patients experienced more frequent adrenergic agonist use, postoperative bleeding, and deep sternal wound infections, leading to longer hospital stays.
Conclusions:
- Bilateral internal thoracic artery (BITA) grafting can be routinely performed in diabetic patients.
- Despite higher complication rates and prolonged hospital stays, BITA grafting does not increase early mortality in diabetic patients.
Background:
Increased risk of postoperative complications limits use of bilateral internal thoracic artery (BITA) grafting in diabetic patients. The authors' experience in routine BITA grafting was reviewed to investigate the impact of diabetes on early outcomes.
Methods:
Among the 4508 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery from January 1999 throughout August 2015, skeletonised BITA grafts were used in 3228 (71.6%) patients, 972 diabetic and 2256 non-diabetic. After one-to-one propensity score (PS)-matched analysis, 819 pairs of diabetic/non-diabetic patients were compared for postoperative outcomes. The operative risk was calculated for each patient according to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).
Results:
Although diabetic had higher risk profiles than non-diabetic patients both in unmatched (EuroSCORE II: 5.3±7.3% vs. 3±4.2%, p<0.0001) and PS-matched series (EuroSCORE II: 5.1±7.1% vs. 3.6±4.3%, p<0.0001), there were no differences in hospital mortality (2.2% vs. 1.8%, p=0.52 and 2.1% vs. 2.3%, p=0.74, respectively). In PS-matched pairs, the use of adrenergic agonists (p=0.03), postoperative bleeding (p=0.0055) and deep incisional sternal wound infection (p=0.0018) were more frequent in diabetic patients who had a mean of longer hospital stays (p=0.023).
Conclusions:
Bilateral internal thoracic artery grafting may be routinely performed even in diabetic patients despite higher risk profiles. Increased postoperative complications prolong hospital stay but do not impact on early mortality.
