Related Experiment Video
Updated: Nov 9, 2025
Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs
Published on: June 23, 2022
Bilateral Internal Thoracic Artery Grafting Improves Survival for Severe Left Ventricular Dysfunction and Diabetes
Satoshi Kainuma1, Koichi Toda1, Takashi Daimon2
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine.
Insights
Diabetic patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) have worse outcomes. Bilateral internal thoracic artery (ITA) grafting may improve survival in these diabetic patients.
Area of Science:
- Cardiology
- Thoracic Surgery
- Diabetology
Background:
- Severe left ventricular (LV) dysfunction poses challenges for coronary artery bypass grafting (CABG).
- The impact of diabetes on CABG outcomes and the benefit of bilateral internal thoracic artery (ITA) grafting in diabetic patients are not well understood.
Purpose of the Study:
- To investigate the association between diabetic status and outcomes after CABG in patients with severe LV dysfunction.
- To evaluate the survival benefit of bilateral ITA grafting in diabetic versus non-diabetic patients undergoing CABG.
Main Methods:
- A cohort of 188 patients with LV ejection fraction ≤40% undergoing isolated initial CABG were classified into non-diabetic, non-insulin-dependent diabetic (NIDM), and insulin-dependent diabetic (IDM) groups.
- Survival rates were analyzed over a mean follow-up of 68 months.
- Multivariate analysis was used to adjust for covariates and assess the impact of bilateral ITA grafting.
Main Results:
- Diabetic patients (NIDM and IDM) had significantly lower 5-year survival rates (65%) compared to non-diabetic patients (84%).
- Both NIDM and IDM were associated with increased mortality risk (HRs 1.9 and 2.4, respectively).
- Bilateral ITA grafting significantly improved survival in diabetic patients (81% vs. 57%) but not in non-diabetic patients (80% vs. 86%).
Conclusions:
- Diabetic status (NIDM and IDM) is linked to worse long-term clinical outcomes following CABG for severe LV dysfunction.
- Bilateral ITA grafting demonstrates potential to enhance survival specifically in diabetic patients with severe LV dysfunction undergoing CABG.
Background:
In patients with severe left ventricular (LV) dysfunction requiring coronary artery bypass grafting (CABG), the association between diabetic status and outcomes after surgery, as well as with survival benefit following bilateral internal thoracic artery (ITA) grafting, remain largely unknown.
Methods And Results:
Patients (n=188; mean [±SD] age 67±9 years) with LV ejection fraction ≤40% who underwent isolated initial CABG were classified into non-diabetic (n=64), non-insulin-dependent diabetic (NIDM; n=74), and insulin-dependent diabetic (IDM; n=50) groups. During follow-up (mean [±SD] 68±47 months), the 5-year survival rate was 84% and 65% among non-diabetic and diabetic patients, respectively (P=0.034). After adjusting for all covariates, both NIDM and IDM were associated with increased mortality, with hazard ratios (HRs) of 1.9 (95% confidence interval [CI] 1.0-3.7; P=0.049) and 2.4 (95% CI 1.2-4.8; P=0.016), respectively. Among non-diabetic patients, there was no difference in the 5-year survival rate between single and bilateral ITA grafting (86% vs. 80%, respectively; P=0.95), whereas bilateral ITA grafting increased survival among diabetic patients (57% vs. 81%; P=0.004). Multivariate analysis revealed that bilateral ITA was significantly associated with a decreased risk of mortality (HR 0.3; 95% CI 0.1-0.8; P=0.024).
Conclusions:
NIDM and IDM were significantly associated with worse long-term clinical outcome after CABG for severe LV dysfunction. Bilateral ITA grafting has the potential to improve survival in diabetic patients with severe LV dysfunction.
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy