Abstract
Objectives Despite encouraging late outcomes, the use of bilateral internal thoracic artery
(BITA) grafting for myocardial revascularization in diabetic patients remains controversial
because of an increased risk of sternal wound complications. In the present study,
early- and long-term outcomes of the use of left-sided BITA versus single internal
thoracic artery (SITA) grafting in young (< 65 years of age) diabetic patients were
reviewed retrospectively.
Methods A total of 250 propensity score pair-matched diabetic patients, operated on between
February 2000 and December 2011, receiving either BITA (n = 125) or SITA (n = 125) grafting were analyzed retrospectively. In each group, 104 patients were males,
and mean age was 60.1 ± 5.3 years. Follow-up was 2.1 to 14.8 years (mean, 9.3 ± 3.5
years) and complete for 100%.
Results Incidence of deep sternal wound infection was 2.4 versus 3.2% (p = 0.722). Rethoracotomy due to bleeding occurred in 4.8 versus 3.2% (p = 0.608). The 5-, 10-, and 14-year estimates of survival were 93.4, 76.6, and 67.5%
(BITA) versus 89.5, 81.5, and 32.8% (SITA); p = 0.288. Freedom from reangiography/intervention (60.5 vs. 63.9%) during follow-up
was comparable (p = 0.507) as well as infarction rate (93.8 vs. 95.1%, p = 0.833) and redoes (p = 0.672, exclusively valve surgery) were comparable. Freedom from thromboembolic
or cerebrovascular events did not show any significant differences (94.0 vs. 94.0%,
p = 0.78). Multivariate analysis identified poor ejection fraction as predictor for
decreased long-term survival. Neither age nor gender or urgency had an influence on
long-term mortality.
Conclusion Left-sided BITA grafting may be performed routinely even in diabetic patients without
increased incidence of postoperative wound-healing complications. Survival rates after
5, 10, and 14 years were comparable for BITA and SITA grafting.
Keywords
coronary artery bypass grafts surgery - CABG - BITA versus SITA - diabetes mellitus
