Double skeletonized internal thoracic artery vs. double conventional internal thoracic artery in diabetic patients submitted to OPCAB.
OBJECTIVE
To evaluate the influence of the technique used in the dissection of thoracic arteries in the evolution of diabetic patients submitted to OPCAB.


METHODS
Seventy diabetic patients submitted to OPCAB using bilateral thoracic arteries were evaluated. In Group A, thoracic arteries were dissected as a pedicle, while in Group B they were skeletonized.


RESULTS
The mean age of patients in Group A was 52.14 +/- 7.35 years old versus 55.71 +/- 8.1 years for Group B (p=0.057). In Group A, six patients (17.1%) were insulin dependent against nine (25.7%) in Group B (p = 0.561). The EUROSCORE was 3.97 +/- 2.49 for Group A opposed to 4.14 +/- 3.06 for Group B (p = 0.879). The number of distal anastomoses in Group A was 3 +/- 0.77 versus 3.03 +/- 0.89 in Group B (p = 0.981). Three patients (8.57%) from Group A presented with mediastinitis. Insulin dependence was the only significant risk factor (p=0.008) for mediastinitis. In this group the use of skeletonized internal thoracic arteries significantly decreased the incidence of mediastinitis (p = 0.044).


CONCLUSIONS
The incidence of mediastinitis was lower in the group for which mammary arteries were dissected using skeletonization. Among insulin-dependent diabetics, 50% of the patients from the group in which the pedicled internal thoracic artery was utilized presented with mediastinitis; the utilization of skeletonized internal thoracic arteries significantly decreases the incidence of mediastinitis.
Milani
Rodrigo
R
PUC/PR, Curitiba, PR, Brasil. rodrigo.milani@sbccv.org.br
Brofman
Paulo Roberto
PR
Guimarães
Maximiliano
M
Barboza
Laura
L
Tchaick
Rodrigo Mezzalira
RM
Meister Filho
Hugo
H
Baggio
Thales
T
Maia
Francisco
F
D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D047549:Coronary Artery Bypass, Off-Pump; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008323:Mammary Arteries / Q000637:transplantation*; D008480:Mediastinitis / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*
D007004:Hypoglycemic Agents; D007328:Insulin