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DOI: 10.1055/s-0043-1761711
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.
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
28 January 2023
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