title: Long-term outcomes of patients with diabetes receiving bilateral internal thoracic artery grafts.
abstract: OBJECTIVE
  Bilateral internal thoracic artery (BITA) grafting in patients with diabetes are controversial because of increased risk of sternal infection. On the other hand, patients with diabetes may benefit from BITA grafts because of the associated improved survival. This study evaluated factors affecting early and long-term outcomes for better selection of patients with diabetes for BITA grafts.
  
  
  METHODS
  Between 1996 and 2006, 69 patients with insulin-treated diabetes and 732 with orally treated diabetes received isolated skeletonized BITA grafts. Of these patients, 338 were younger than 65 years, 322 were between 65 and 74 years old, and 141 were 75 years or older.
  
  
  RESULTS
  Operative mortality was lower than logistic EuroSCORE-calculated mortality (2.9% vs 7%, P < .001). Predictors of increased mortality were critical preoperative state (P < .001) and age (P = .008). There were 30 cases of sternal infection (3.7%); predictors were reoperation (P < .001), peripheral vascular disease (P = .009), obesity (P = .012), chronic lung disease (P = .009), and female sex (P = .020). Mean follow-up was 8.4 ± 4 years. Kaplan-Meier 10-year survivals were 75%, 59%, and 39% for patients younger than 65, 65 to 74, and at least 75 years, respectively (P < .001). They were better than corresponding Charlson comorbidity index-predicted survivals (36%, 10%, and 3%, respectively; P < .001). Predictors of decreased survival were age (P < .001), congestive heart failure (P < .001), and peripheral vascular disease (P < .001). Off-pump surgery was independently associated with better long-term survival (P = .003).
  
  
  CONCLUSIONS
  BITA grafts are safe in patients with diabetes. Favorable short- and long-term outcomes outweigh increased sternal infection risk.
authors.affiliation: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Hemo
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
authors.forename: Goni
authors.initials: G
authors.lastname: Katz
authors.forename: Nataly
authors.initials: N
authors.lastname: Popovits
authors.forename: Dmitry
authors.initials: D
authors.lastname: Pevni
authors.forename: Benjamin
authors.initials: B
authors.lastname: Medalion
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome