HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Rephael Mohr Menachem Matsa Gideon Uretzky Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lev-Ran, O. Articles by Uretzky, G. Search for Related Content PubMed PubMed Citation Articles by Lev-Ran, O. Articles by Uretzky, G.

Ann Thorac Surg 2003;75:1872-1877
© 2003 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Bilateral internal thoracic artery grafting in Insulin-Treated diabetics: should it be avoided?

^a Department of Cardiothoracic Surgery, The Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
^b The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Accepted for publication December 31, 2002.

^* Address reprint requests to Dr Lev-Ran, Department of Cardiothoracic Surgery, The Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
e-mail: orenlevran{at}hotmail.com

BACKGROUND: It has been advocated that skeletonized bilateral internal thoracic artery (BITA) grafting may be implemented safely in diabetics, thus bestowing these patients with the long-term benefits of this strategy. However, the feasibility of this approach in insulin-treated patients has yet to be determined.

METHODS: One-hundred twenty-four insulin-treated diabetics, operated on between April 1996 and December 2001, were compared according to the surgical technique used: BITA (n = 50) or single internal thoracic artery (SITA; n = 74). In the latter, complementary grafts used were saphenous veins and radial arteries.

RESULTS: The groups had comparable risk profiles, with the exception of more neurologic events in the SITA group (21% vs 4%, p = 0.008). There was no significant difference in 30-day mortality (6% vs 4%, p = 0.684), nor in the incidence of neurologic complications (2% vs 8%, p = 0.240). The rate of sternal infection was comparable (4% vs 2.7%, p = 1.000). Use of BITAs was associated with a lower return of angina (4% vs 20%, p = 0.025), less cardiac events (17% vs 38%, p = 0.01), and reduced cardiac mortality (none vs 10%, p = 0.04). Despite the similar 6-year survival (80.5% and 77.4%, p = NS), cardiac-related event-free survival was better in BITA patients (69% vs 23%, p < 0.0001). Multivariate analysis identified use of BITA as a protective factor resulting in less return of angina (p = 0.007) and improved cardiac-related event-free survival (p = 0.001).

CONCLUSIONS: Skeletonized BITA grafting can be performed in insulin-treated diabetics at acceptable risk. This approach may confer improved cardiac outcome. Thus, it should be considered in selected patients.

This article has been cited by other articles:

				D. Pevni, G. Uretzky, A. Mohr, R. Braunstein, A. Kramer, Y. Paz, I. Shapira, and R. Mohr Routine Use of Bilateral Skeletonized Internal Thoracic Artery Grafting: Long-Term Results Circulation, August 12, 2008; 118(7): 705 - 712. [Abstract] [Full Text] [PDF]

				Z. I. Khalpey, R. B. Ganim, and J. D. Rawn Postoperative Care of Cardiac Surgery Patients Card. Surg. Adult, January 1, 2008; 3(2008): 465 - 486. [Full Text]

				E. Gongora and T. M. Sundt III Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 599 - 632. [Full Text]

				M. Kai, M. Hanyu, Y. Soga, T. Nomoto, J. Nakano, T. Matsuo, E. Umehara, M. Kawato, and H. Okabayashi Off-Pump Coronary Artery Bypass Grafting With Skeletonized Bilateral Internal Thoracic Arteries in Insulin-Dependent Diabetics Ann. Thorac. Surg., July 1, 2007; 84(1): 32 - 36. [Abstract] [Full Text] [PDF]

				T. Ohno, J. Ando, M. Ono, T. Morita, N. Motomura, Y. Hirata, and S. Takamoto The beneficial effect of coronary-artery-bypass surgery on survival in patients with diabetic retinopathy Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 881 - 886. [Abstract] [Full Text] [PDF]

				Prostaglandin E2 EP4 receptor-selective agonist facilitates sternal healing after harvesting bilateral internal thoracic arteries in diabetic rats. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 587 - 593.

				I. K. Toumpoulis, C. E. Anagnostopoulos, S. Balaram, D. G. Swistel, R. C. Ashton Jr, and J. J. DeRose Jr Does Bilateral Internal Thoracic Artery Grafting Increase Long-Term Survival of Diabetic Patients? Ann. Thorac. Surg., February 1, 2006; 81(2): 599 - 607. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. Di Mauro, G. Di Giammarco, G. Teodori, A. L. Iaco, V. Mazzei, G. Vitolla, and M. Contini Single Versus Bilateral Internal Mammary Artery for Isolated First Myocardial Revascularization in Multivessel Disease: Long-Term Clinical Results in Medically Treated Diabetic Patients Ann. Thorac. Surg., September 1, 2005; 80(3): 888 - 895. [Abstract] [Full Text] [PDF]

				O. Lev-Ran, R. Braunstein, N. Nesher, Y. Ben-Gal, G. Bolotin, and G. Uretzky Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis Ann. Thorac. Surg., June 1, 2004; 77(6): 2039 - 2045. [Abstract] [Full Text] [PDF]

				T. Athanasiou, M.-C. Crossman, G. Asimakopoulos, A. Cherian, A. Weerasinghe, B. Glenville, and R. Casula Should the internal thoracic artery be skeletonized? Ann. Thorac. Surg., June 1, 2004; 77(6): 2238 - 2246. [Abstract] [Full Text] [PDF]