title: 14-Year Results of Bilateral versus Single Internal Thoracic Artery Grafts for Left-Sided Myocardial Revascularization in Young Diabetic Patients.
abstract: ObjectivesDespite encouraging late outcomes, the use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization in diabetic patients remains controversial because of an increased risk of sternal wound complications. In the present study, early- and long-term outcomes of the use of left-sided BITA versus single internal thoracic artery (SITA) grafting in young (< 65 years of age) diabetic patients were reviewed retrospectively.MethodsA total of 250 propensity score pair-matched diabetic patients, operated on between February 2000 and December 2011, receiving either BITA (n= 125) or SITA (n= 125) grafting were analyzed retrospectively. In each group, 104 patients were males, and mean age was 60.1 ± 5.3 years. Follow-up was 2.1 to 14.8 years (mean, 9.3 ± 3.5 years) and complete for 100%.ResultsIncidence of deep sternal wound infection was 2.4 versus 3.2% (p= 0.722). Rethoracotomy due to bleeding occurred in 4.8 versus 3.2% (p= 0.608). The 5-, 10-, and 14-year estimates of survival were 93.4, 76.6, and 67.5% (BITA) versus 89.5, 81.5, and 32.8% (SITA);p= 0.288. Freedom from reangiography/intervention (60.5 vs. 63.9%) during follow-up was comparable (p= 0.507) as well as infarction rate (93.8 vs. 95.1%,p= 0.833) and redoes (p= 0.672, exclusively valve surgery) were comparable. Freedom from thromboembolic or cerebrovascular events did not show any significant differences (94.0 vs. 94.0%,p= 0.78). Multivariate analysis identified poor ejection fraction as predictor for decreased long-term survival. Neither age nor gender or urgency had an influence on long-term mortality.ConclusionLeft-sided BITA grafting may be performed routinely even in diabetic patients without increased incidence of postoperative wound-healing complications. Survival rates after 5, 10, and 14 years were comparable for BITA and SITA grafting.
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gansera
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany.
authors.forename: Alem
authors.initials: A
authors.lastname: Delalic
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany.
authors.forename: Edgar
authors.initials: E
authors.lastname: Eszlari
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Eichinger
mesh_terms: D000367:Age Factors; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome