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Does bilateral internal thoracic artery grafting increase surgical risk in diabetic patients?
M S Uva1, E Braunberger, M Fisher
1Department of Cardiac Surgery, Hôpital Saint Joseph, Paris, France.
Insights
Double internal thoracic artery (ITA) bypass surgery in diabetic patients showed no increased mortality or morbidity. This technique, using ITA skeletonization, may reduce sternal wound infections in diabetic patients.
Area of Science:
- Cardiovascular Surgery
- Diabetic Medicine
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for diabetic patients.
- The use of bilateral internal thoracic arteries (ITAs) in CABG has potential benefits but requires careful patient selection and surgical technique.
- Assessing the safety and efficacy of double ITA revascularization in diabetic populations is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of double internal thoracic artery (ITA) coronary bypass in diabetic patients.
- To determine if diabetic patients can benefit from double ITA grafting without increased hospital risk.
- To compare outcomes between diabetic patients receiving bilateral ITA grafts versus single ITA or vein grafts.
Main Methods:
- A retrospective study of 207 diabetic patients undergoing CABG between 1990 and 1996.
- Patients were divided into two groups: bilateral ITA (n=74) and nonbilateral ITA (n=133).
- ITAs were harvested using skeletonization without electrocautery, with strict glycemic control maintained.
Main Results:
- The bilateral ITA group experienced no deaths, while the nonbilateral group had 7 deaths (p<0.05).
- No deep sternal wound infections occurred in the bilateral ITA group, compared to 1.5% in the nonbilateral group (p=NS).
- Morbidity rates were similar, with greater blood loss noted in the bilateral ITA group.
Conclusions:
- Double ITA coronary revascularization is feasible and safe in young diabetic patients, showing no increase in morbidity or mortality.
- The skeletonization technique for ITA harvesting may contribute to a low rate of sternal wound infections.
- Larger studies are needed to validate these findings and confirm the benefits of double ITA grafting in diabetic populations.
Background:
The purpose of this study was to determine whether, with appropriate techniques, diabetic patients could benefit from the advantages of double internal thoracic artery (ITA) coronary bypass without an increased hospital risk.
Methods:
Between January 1990 and December 1996, 207 consecutive diabetic patients underwent coronary artery bypass graft operations. In 74 patients both arteries (bilateral ITA group) were used, whereas 133 patients received one ITA and vein grafts or vein grafts alone (nonbilateral group). Patients in the bilateral ITA group were younger (p<0.0001), predominantly male (p<0.0001), and were operated on more electively. The internal thoracic arteries were harvested by skeletonization without electrocautery, and strict glycemic control was pursued.
Results:
No death was observed in the bilateral ITA group, whereas 7 patients died in the nonbilateral ITA group (p<0.05). Deep sternal wound infection was observed in 2 patients in the nonbilateral ITA group (1.5%) and in none of the bilateral ITA group (p = NS). There was no significant difference in the morbidity rate between the two groups except for greater blood losses in the bilateral ITA group.
Conclusion:
Double ITA coronary revascularization in young diabetic patients was performed without increased morbidity and mortality. The low rate of sternal wound infections may be related to ITA harvesting by a skeletonization technique, but larger studies are required to confirm these data.