Bilateral internal thoracic artery grafting in insulin-treated diabetes.
Asian Cardiovasc Thorac Ann
; 21(6): 661-8, 2013 Dec.
Article
in En
| MEDLINE
| ID: mdl-24569323
ABSTRACT
BACKGROUND:
We sought to assess the risk and late outcome of bilateral internal thoracic artery grafting in eligible insulin-treated diabetic subsets.METHODS:
147 insulin-treated diabetic patients undergoing arterial revascularization were grouped as skeletonized bilateral internal thoracic artery (n = 83) or internal thoracic artery-radial artery (n = 64). Chronic lung disease or overweight and female constituted exclusion criteria for bilateral internal thoracic artery grafts.RESULTS:
Patients who had bilateral internal thoracic artery grafts were younger and comprised fewer females. Left-sided bilateral internal thoracic artery configurations were predominantly applied. Despite mean hemoglobin A1c of 8.0% ± 1% (range, 7%-13.5%) respective rates of deep sternal infection in bilateral internal thoracic artery and radial artery patients were 1.2% and 0%; superficial wound infection occurred in 3.1% and 3.6%, respectively. One sternoplasty was performed. Bilateral internal thoracic artery grafting did not correlate with sternal complications (odds ratio = 2.24, 95%CI 0.56-8.95, p = 0.256). Of the radial artery conduits, 98% were adequate, and procurement-site complications occurred in 3.1%. Follow-up was 2-58 months (median, 25 months). Five-year survival was comparable in the 2 groups (p = 0.360). Bilateral internal thoracic artery grafting did not reduce late major adverse cardiac events (p = 0.729) or late mortality (p = 0.384).CONCLUSIONS:
Skeletonized bilateral internal thoracic artery grafts can be used with acceptable risk in a substantial portion of insulin-treated diabetic patients, so it should not be automatically denied, but the choice of such grafts is not associated with midterm cardiac benefits.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coronary Artery Disease
/
Diabetes Mellitus
/
Diabetic Angiopathies
/
Hypoglycemic Agents
/
Insulin
/
Internal Mammary-Coronary Artery Anastomosis
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Asian Cardiovasc Thorac Ann
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2013
Document type:
Article
Affiliation country:
Israel