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Ann Thorac Surg 2008;85:690. doi:10.1016/j.athoracsur.2007.06.087
© 2008 The Society of Thoracic Surgeons
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Correspondence

Use of Both Internal Thoracic Arteries in Diabetic Patients

Rafael Martínez-Sanz, MD, Ramiro de la Llana, MD, Ibrahim Nassar, MD, Pilar Garrido, MD

Hospital Universitario de Canarias, University of La Laguna, Department of Thoracic and Cardiovascular Surgery, Tenerife 38320, Spain

(Email: drmartinezsanz{at}hotmail.com).

To the Editor:

We agree with Dr Savage and colleagues’ conclusions [1] regarding possible limitations in the use of both internal thoracic arteries (BITA) in diabetic patients. Despite the excellent mid-term and long-term results using BITA in both permeability rates and survival and cardiac adverse events free curves, only 4% of cardiothoracic surgeons use it in North America [2]. We could state that choosing the routine use of BITA in surgical coronary revascularization is the "politically correct" option [3, 4] from an academic perspective, although statistics reveal that only few are using it.

However, the use of BITA is not always advantageous because it can increase the prevalence of sternotomy-related complications due to the induced ischemia in the side-sternal area after dissecting BITA collaterals. This is especially clear in diabetic patients, in particular if they are old, female, obese or bronchitic [1–5]. Therefore, we think that the use of BITA in diabetic patients should be reconsidered based on the presence of these comorbidities, and that it should probably be discarded if two or more coexist, regardless of the skeletonizing of BITA and an aggressive insulin treatment during early post-surgery to avoid the risk of deep wound infection [2, 6].


   References
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 References
 

  1. Savage EB, Grab JD, O’Brien SM. Use of both internal thoracic arteries in diabetics increases deep sternal wound infection Ann Thorac Surg 2007;83:1002-1007.[Abstract/Free Full Text]
  2. Douville E. Use of both internal thoracic arteries in diabetics increases deep sternal wound infection Ann Thorac Surg 2007;83:1007.[Free Full Text]
  3. 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]
  4. Rankin JS, Tuttle RH, Wechsler AS, et al. Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up Ann Thorac Surg 2007;83:1008-1015.[Abstract/Free Full Text]
  5. De la Llana R, Echevarria JR, Fernandez JM, Martinez-Sanz R. Use of both internal mammary arteries; not everything is advantageous Rev Esp Cardiol 1989;42:593-596.[Medline]
  6. 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]

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Edward B. Savage
Ann. Thorac. Surg. 2008 85: 690. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., February 1, 2008; 85(2): 690 - 690.
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