Pure Bilateral Internal Thoracic Artery Grafting in Diabetic Patients With Triple-Vessel Disease.
BACKGROUND
Despite the documented superior long-term patency of bilateral internal thoracic artery (BITA) grafting, use of BITAs remains low, especially in diabetic patients. We analyzed the results of pure BITA grafting to determine whether the potential survival advantage outweighs the risk of wound infection in diabetic patients.


METHODS
We performed a retrospective analysis of 791 consecutive patients (389 diabetic, 402 nondiabetic) with triple-vessel disease who underwent off-pump coronary artery bypass using only skeletonized BITAs from 2001 to 2010. We used propensity score matching to match 315 nondiabetic patients with diabetic patients.


RESULTS
The groups did not differ significantly regarding 10-year survival (diabetic, 84.2% ± 4.5%; nondiabetic, 80.8% ± 4.7%; p = 0.828) or freedom from major adverse cardiovascular events (diabetic, 73.5% ± 5.2%; nondiabetic, 71.8% ± 5.3%; p = 0.431). Diabetes was not predictive of deep sternal infection (odds ratio, 1.11; 95% confidence interval, 0.23 to 5.31; p = 0.895). Results of stratified competing risks regression analysis showed that the risk of target vessel revascularization in diabetic patients was similar to that of nondiabetic patients (subdistribution hazard ratio, 0.67; 95% confidence interval, 0.16 to 2.80; p = 0.585).


CONCLUSIONS
Off-pump coronary artery bypass grafting using pure BITAs produced excellent clinical outcomes in both diabetic and nondiabetic patients. This strategy did not increase the incidence of deep sternal infection in diabetic patients. We recommend BITA grafting, which has proven long-term patency, as a strategy of choice in diabetic patients.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Dong Seop
DS
Jeong
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kiick
K
Sung
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: ytlee1955@gmail.com.
Young Tak
YT
Lee
Department of Mathematical and Statistical Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Joong Hyun
JH
Ahn
Department of Mathematical and Statistical Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
K C
KC
Carriere
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Wook Sung
WS
Kim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Pyo Won
PW
Park
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome