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Ann Thorac Surg 2007;83:1007
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Division of Thoracic and Cardiovascular Surgery, The Oregon Clinic, PC, 1111 NE 99th Ave, Suite 201, Portland, OR 97220

(Email: ecdouville{at}orclinic.com).

Unfortunately, less than 4% of all coronary artery bypass grafting patients in the 2003 Society of Thoracic Surgeons’ database benefited from bilateral internal thoracic artery (BITA) grafting, despite evidence of better long-term survival [1]. Although BITA grafting in diabetics has long been considered an independent risk factor for deep sternal wound infection (DSWI), evidence that aggressive perioperative glucose control reduces DSWI [2] has led some to postulate that BITA grafting may be reasonable in diabetics.

Savage and colleagues [3] have mined the rich STS database to investigate this further and report higher DSWI rates in BITA than single internal thoracic artery (ITA) diabetic patients (2.8 versus 1.7%) without impact on mortality. However there are several problems with this retrospective report. More than 98% of the diabetic patients in the series received single ITA grafts; the 1.4% (n = 1,932) who received BITA grafts were less often insulin dependent and were significantly younger and healthier. Although they found no increase in mortality in those diabetic DSWI patients with BITA grafts, it is important for surgeons to remember that these infections are devastating and at a minimum they mean a protracted and expensive recovery for patients.

The data presented by Savage and colleagues [3] should not be taken to mean that routine BITA grafting in diabetics is the procedure of choice at this time. Although adjuncts such as ITA skeletonization and optimal perioperative glucose control may ultimately help prove this to be true, we await other reports about the safety of BITA grafting in diabetics.

	References

Top References

 

1. Lytle BW, Blackstone EH, Sabik JF, et al. The effect of bilateral internal thoracic artery grafting on survival over 20 postoperative years Ann Thorac Surg 2004;78:2005-2014.[Abstract/Free Full Text]
2. Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures Ann Thorac Surg 1999;67:352-360.[Abstract/Free Full Text]
3. Savage EB, Grab JD, O’Brien SM, et al. Use of both internal thoracic arteries in diabetics increases deep sternal wound infection Ann Thorac Surg 2007;83:1002-1007.[Abstract/Free Full Text]

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				R. Martinez-Sanz, R. de la Llana, I. Nassar, and P. Garrido Use of Both Internal Thoracic Arteries in Diabetic Patients Ann. Thorac. Surg., February 1, 2008; 85(2): 690 - 690. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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): Emery Charles Douville Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Douville, E. C. Search for Related Content PubMed PubMed Citation Articles by Douville, E. C. Related Collections Coronary disease Related Article