title: In-hospital outcomes of pedicled bilateral internal mammary artery use in diabetic and nondiabetic patients undergoing off-pump coronary artery bypass grafting: single-surgeon, single-center experience.
abstract: OBJECTIVE
  A common perception is that use of pedicled bilateral internal mammary arteries (BIMA) increases the risk of sternal wound complications in diabetic patients undergoing coronary artery bypass grafting (CABG). The purpose of this study was to compare the in-hospital outcomes of CABG using pedicled BIMA in diabetic and nondiabetic patients.
  
  
  METHODS
  From September 1998 to September 2010, 390 consecutive diabetic patients and 519 nondiabetic patients underwent isolated off-pump CABG using pedicled BIMA. The 2 groups had comparable preoperative demographics except for a higher prevalence of acute myocardial infarction (18.9% versus 6.1%, P = .01), peripheral vascular disease (17.2% versus 2.7%, P = .001), an ejection fraction <30% (17.7% versus 8.5%, P = .02), and chronic renal failure (4.5% versus 0.9%, P = .01) in the diabetic patients.
  
  
  RESULTS
  The operative mortality rate of the diabetic patients was comparable to that of the nondiabetic patients (2.8% versus 2.1%, P = .87). The in-hospital outcomes, including occurrence of superficial and deep sternal wound infections, were similar except for an increased occurrence of wound infection at the vein harvest site (6.6% versus 1.1%, P = .04) and a need for hemofiltration (11.8% versus 2.1%, P = .02) in the diabetic patients.
  
  
  CONCLUSIONS
  Pedicled BIMA use is associated with comparable incidences of sternal wound complications and other outcomes in diabetic patients and nondiabetic patients. Strict perioperative glycemic control, adherence to meticulous closure technique, and postoperative management of surgical wounds can make pedicled BIMA use a default strategy for diabetic patients.
authors: Department of Cardiac Surgery, Harefield Hospital, London, UK. drrajashahzad@hotmail.com
authors: Shahzad G
authors: SG
authors: Raja
authors: Kareem
authors: K
authors: Salhiyyah
authors: Muhammad Umar
authors: MU
authors: Rafiq
authors: Manoraj
authors: M
authors: Navaratnarajah
authors: Dimple
authors: D
authors: Chudasama
authors: Christopher P
authors: CP
authors: Walker
authors: Fouad
authors: F
authors: Amin
authors: Mohamed
authors: M
authors: Amrani
mesh_terms: D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D048909:Diabetes Complications / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality* / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D013524:Surgical Flaps / Q000706:statistics & numerical data / Q000637:transplantation; D013530:Surgical Wound Infection / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome