Objective: Increased risk of deep sternal infections has prohibited routine
bilateral internal thoracic artery grafting in diabetic patients, The tech
nique for harvesting the skeletonized internal thoracic artery provides the
potential to minimize this risk. The purpose of this study was to compare
the outcome of bypass grafting with bilateral skeletonized internal thoraci
c arteries in diabetic and nondiabetic patients.
Methods: From May 1996 to April 1998, 231 consecutive diabetic and 534 nond
iabetic patients underwent bilateral skeletonized internal thoracic artery
grafting. Mean age was 66 years. Compared with the nondiabetic group, the d
iabetic group comprised more women (29% vs 18%, P = .001), had a greater pr
evalence of hypertension (53% vs 44%, P = .019) and congestive heart failur
e (20% vs 14%, P = .016), but a lower prevalence of preoperative acute myoc
ardial infarction (26% vs 34%, P = .027).
Results: Operative mortality of diabetic patients was comparable with that
of nondiabetic patients (3% vs 2.6%). The two groups also had similar occur
rences of deep sternal infection (2.6% vs 1.7%, respectively, P = .40), Dee
p sternal infection was significantly more prevalent in obese, diabetic wom
en (3/20 = 15%) than in diabetic patients without this combination of risk
factors (3/211 = 1.4%, P < .0001) (odds ratio 11.1, confidence interval 2.1
-59.4). Diabetic patients also had a higher incidence of stroke (3.5% vs 0.
9%, P = .014). Three-year actuarial survival of diabetic patients was lower
(91.3% vs 94.7%, P = .083).
Conclusions: Bilateral skeletonized internal thoracic artery grafting is a
good surgical revascularization option in diabetic patients. Operative mort
ality and prevalence of sternal infection are comparable with those of nond
iabetic patients. However, the risk of sternal infection in obese diabetic
women is high, and for them we advocate the use of a single artery instead
of bilateral internal thoracic arteries.