Bilateral Skeletonized Internal Mammary Artery in Insulin-Dependent Diabetic Patients

Background: Guidelines recommend surgical coronary revascularization in diabetic patients with multivessel disease. Bilateral internal mammary artery (BIMA) grafting in patients with insulin-dependent diabetes mellitus (IDDM) undergoing coronary artery bypass grafting (CABG) remains controversial. BIMA grafting in a skeletonized technique may be beneficial in these patients. We herein report our experience in this patient cohort.

Method: From December 2009 to December 2021, a total of 7,347 patients received CABG including 195 patients with IDDM. 50 (25.50%) patients (group 1) received CABG with skeletonized BIMA. This group was compared with 145 (74.36%) IDDM patients (group 2) with different bypass grafting techniques. Data were retrospectively analyzed according to MACE criteria definitions.

Results: Baseline characteristics were comparable in both groups in terms of gender (group 1: 18.15% female vs. group 2: 23.45%; p = 0.11) with a mean age of 64.00 ± 8.00 years in group 1 and 68.00 ± 11.00 years in group 2 (p = 0.015). The mean log EuroSCORE was 1.15 ± 0.44 in group 1 versus 3.43 ± 4.55 (p < 0.001) in group 2 and a STS mortality score of 0.79 ± 0.54 in group 1 versus 2.30 ± 1.80 in group 2 (p = 0.016). The morbidity score was significantly lower in group 1 with 6.72 ± 3.70 versus 14.30± 11.70 in group 2 (p = 0.0005). Arterial hypertension was less included in group 1 (67.00 vs. 90.30%; p = 0.028), while creatinine levels were higher in group 1 (1.71 ± 1.67 mg/dL vs. 1.39 ± 1.00; p < 0.001). In group 1, more patients with left-main stenosis (32.00 vs. 15.68%; p = 0.026) but fewer cases of NSTEMI constellations (16.00 vs. 42.8%; p = 0.01) and urgent CABG procedures (2.00 vs. 17.20% in group 2; p = 0.016) were noticed. Procedure time was significantly longer in group 1 (282.0 ± 92.0 minutes vs. 234.00 ± 92.00 min; p = 0.002). Complete revascularization was more frequent in group 1 (68.00 vs. 50.34%; p = 0.023), while the composite endpoint of renal failure was less frequent in group 1 (2.00 vs. 29.00%; p = 0.024). There was no significant difference in MACE criteria including 30-day mortality, rethoracotomy, postoperative myocardial infarction, stroke, and wound infection within both groups.

Conclusion: In this subgroup of patients with IDDM and skeletonized BIMA undergoing CABG, complete arterial revascularization was safely performed with no impact on sternal wound infection or 30-day mortality. Procedure time was significantly longer in IDDM with skeletonized BIMA, but a higher rate of complete revascularization was achieved. No difference in wound infection between groups was recognized.

Publication History

Article published online:
28 January 2023