Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus

Citation
M. Matsa et al., Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus, J THOR SURG, 121(4), 2001, pp. 668-674
Citations number
32
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN journal
0022-5223 → ACNP
Volume
121
Issue
4
Year of publication
2001
Pages
668 - 674
Database
ISI
SICI code
0022-5223(200104)121:4<668:BSITAG>2.0.ZU;2-K
Abstract
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.