Bilateral internal thoracic artery grafting in insulin-treated diabetes

Oren Lev-Ran, Menachem Matsa, Yaron Ishay, Moataz Abo Abod, Alina Vodonos, Gideon Sahar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: We sought to assess the risk and late outcome of bilateral internal thoracic artery grafting in eligible insulin-treated diabetic subsets. Methods: 147 insulin-treated diabetic patients undergoing arterial revascularization were grouped as: skeletonized bilateral internal thoracic artery (n=83) or internal thoracic artery-radial artery (n=64). Chronic lung disease or overweight and female constituted exclusion criteria for bilateral internal thoracic artery grafts. Results: Patients who had bilateral internal thoracic artery grafts were younger and comprised fewer females. Left-sided bilateral internal thoracic artery configurations were predominantly applied. Despite mean hemoglobin A1c of 8.0%±1% (range, 7%-13.5%) respective rates of deep sternal infection in bilateral internal thoracic artery and radial artery patients were 1.2% and 0%; superficial wound infection occurred in 3.1% and 3.6%, respectively. One sternoplasty was performed. Bilateral internal thoracic artery grafting did not correlate with sternal complications (odds ratio=2.24, 95%CI: 0.56-8.95, p=0.256). Of the radial artery conduits, 98% were adequate, and procurement-site complications occurred in 3.1%. Follow-up was 2-58 months (median, 25 months). Five-year survival was comparable in the 2 groups (p=0.360). Bilateral internal thoracic artery grafting did not reduce late major adverse cardiac events (p=0.729) or late mortality (p=0.384). Conclusions: Skeletonized bilateral internal thoracic artery grafts can be used with acceptable risk in a substantial portion of insulin-treated diabetic patients, so it should not be automatically denied, but the choice of such grafts is not associated with midterm cardiac benefits.

Original languageEnglish
Pages (from-to)661-668
Number of pages8
JournalAsian Cardiovascular and Thoracic Annals
Volume21
Issue number6
DOIs
StatePublished - 1 Dec 2013
Externally publishedYes

Keywords

  • Coronary artery bypass
  • diabetes mellitus
  • glycosylated
  • hemoglobin A
  • mammary arteries
  • treatment outcome

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