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