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Bilateral internal thoracic artery grafting in haemodialysis patients with diabetic nephropathy

Kohei Hachiro1, Takeshi Kinoshita1, Tomoaki Suzuki1

  • 1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.

Interactive Cardiovascular and Thoracic Surgery
|November 25, 2020
PubMed

Insights

Bilateral internal thoracic artery (ITA) grafting did not improve mid-term outcomes for patients with diabetic nephropathy on haemodialysis undergoing coronary artery bypass grafting (CABG). No significant differences were found in mortality or deep sternal wound infection rates.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Diabetology

Background:

  • Patients with diabetic nephropathy on haemodialysis represent a high-risk group for cardiovascular surgery.
  • Internal thoracic artery (ITA) grafting is a preferred method for myocardial revascularization.
  • The use of bilateral versus single skeletonized ITA in this specific patient population remains unclear.

Purpose of the Study:

  • To compare postoperative outcomes of isolated coronary artery bypass grafting (CABG) using bilateral versus single skeletonized internal thoracic artery (ITA) in patients with diabetic nephropathy receiving haemodialysis.

Main Methods:

  • Retrospective analysis of 107 patients with diabetic nephropathy on haemodialysis undergoing isolated CABG between 2002 and 2019.
  • Inverse probability of treatment weighting was used to balance preoperative characteristics.
  • Off-pump myocardial revascularization was performed in all patients.

Main Results:

  • No statistically significant differences in preoperative characteristics were observed after weighting.
  • Postoperative deep sternal wound infection and 30-day mortality showed no significant differences between groups.
  • The bilateral ITA group had a significantly lower rate of postoperative stroke (0% vs 5.5%, P=0.021).
  • Mid-term follow-up (mean 3.3 years) revealed no significant differences in all-cause death (P=0.558) or cardiac death rates (P=0.727).
  • Independent predictors of all-cause death included age, previous percutaneous intervention, and gastroepiploic artery grafting.

Conclusions:

  • Bilateral ITA grafting in patients with diabetic nephropathy receiving haemodialysis did not improve mid-term outcomes compared to single ITA grafting.
  • While bilateral ITA grafting may reduce stroke risk, it does not confer survival benefits in this high-risk cohort.
Abstract

Keywords:
Coronary artery bypass graftingDiabetic nephropathyHaemodialysis patients

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