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Ann Thorac Surg 1999;68:626-627
© 1999 The Society of Thoracic Surgeons

Correspondence

Bilateral internal thoracic arteries and diabetes

Andrew Chukwuemeka, FRCSa, Andrew T. Forsyth, FRACSa

a Department of Cardiothoracic Surgery, King’s College Hospital, London SE5 9RS, England, United Kingdom

e-mail: andrew.sara{at}btinternet.com

To the Editor

It was with great interest that we read the article by Sousa Uva and associates [1] supporting the use of both internal thoracic arteries (ITA) for coronary artery bypass grafting (CABG) in young diabetic patients.

We performed CABG using both ITAs in 375 diabetic patients between 1992 and 1998, and similarly found no significant difference in morbidity or mortality between this group and diabetic patients who had a single ITA graft during the same period. In particular, no significant difference was found in the rate of sternal wound infections even though we do not skeletonize the ITA as Sousa Uva suggests. In addition, we employ a less strict regimen of glycemic control and we do not exclude patients over the age of 75 years from bilateral ITA grafting. Elective and emergency cases were included in both the single and the bilateral ITA groups.

Our analysis is similarly retrospective, and the probability of an element of intentional selection should be borne in mind. We have concluded that in our institution, CABG using both ITAs can be performed safely in diabetic patients in both the elective and emergency setting. We place a greater emphasis on minimal use of diathermy during ITA harvest and meticulous wound closure than on very strict glycemic control and skeletonization of the ITA. We do, however, strongly support the view that large-scale, prospective, randomized studies are needed, to demonstrate more conclusively whether a strategy that we have used with success can be applied more generally.

References

  1. Sousa Uva M., Braunberger E., Fisher M., et al. Does bilateral internal thoracic artery grafting increase surgical risk in diabetic patients?. Ann Thorac Surg 1998;66:2051-2055.[Abstract/Free Full Text]




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