Original articleCardiovascularSingle Versus Bilateral Internal Mammary Artery for Isolated First Myocardial Revascularization in Multivessel Disease: Long-Term Clinical Results in Medically Treated Diabetic Patients
Section snippets
Material and Methods
From October 1991 to December 2001, 558 medically treated diabetic patients affected by multivessel coronary disease underwent coronary artery bypass grafting (CABG) using LIMA to the left anterior descending artery (LAD) and SVG (n = 217), or BIMA (one IMA always to the LAD) with or without SVG (n = 341). Propensity score analysis was used to select 400 patients (71.6%), matching each LIMA + SVG with a BIMA ± SVG with the nearest propensity score. Two groups of patients (LIMA group and BIMA
Results
The operative details are reported in Table 2. In the LIMA group, the internal mammary artery was anastomosed always to the LAD, in 39 cases sequentially with the diagonal. In the BIMA group, an IMA (the left in 115 cases [57.5%], and the right in 85 cases [42.5%]) was always anastomosed to the LAD, whereas the diagonal was sequentially grafted with an IMA in 28 cases (14.0%). The remaining IMA was grafted to the circumflex artery system in 173 patients (86.5%) and to the right coronary artery
Comment
The prevalence of diabetic patients referred to surgical or percutaneous coronary revascularization has remarkably increased, reaching 25% in the United States [13]. Diabetes mellitus represents one of the most important limitations for PTCA. Indeed, most of the previous studies comparing PTCA and CABG have fully demonstrated that diabetic patients, treated with PTCA, have lower survival [14, 15, 16, 17] and significantly higher restenosis and reintervention rate [16, 17, 18]. Therefore, most
References (26)
- et al.
Two internal thoracic artery grafts are better than one
J Thorac Cardiovasc Surg
(1999) - et al.
Single versus bilateral internal mammary artery grafts10-year outcome analysis
Ann Thorac Surg
(1997) - et al.
Better ischemic event-free survival after two internal thoracic artery grafts13 years of follow up
Ann Thorac Surg
(2001) - et al.
Does bilateral internal mammary artery grafting increase surgical risk?
J Thorac Cardiovasc Surg
(1988) - et al.
Bilateral internal mammary artery graftingmidterm results of pedicled versus skeletonized conduits
Ann Thorac Surg
(1999) - et al.
Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus
J Thorac Cardiovasc Surg
(2001) - et al.
Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes
J Thorac Cardiovasc Surg
(2003) - et al.
Difference in mortality of the CABRI diabetic and nondiabetic population and its relation to coronary artery disease and revascularization mode
Am J Cardiol
(2001) - et al.
Eight-year mortality in the Emory Angioplasty versus Surgery Trial (EAST)
J Am Coll Cardiol
(2000) - et al.
Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease
J Am Coll Cardiol
(1998)
Trends in coronary artery bypass surgery resultsa recent 9-year study
Ann Thorac Surg
Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection diabetic patients after cardiac surgical procedures
Ann Thorac Surg
Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients
J Am Coll Cardiol
Cited by (44)
Effect of bilateral internal thoracic artery harvesting on deep sternal wound infection in diabetic patients: Review of literature
2021, Annals of Medicine and SurgeryIs the era of bilateral internal thoracic artery grafting coming for diabetic patients? An updated meta-analysis
2019, Journal of Thoracic and Cardiovascular SurgerySpending 30 minutes to add years to a patient's life: Why is the last step so difficult?
2015, Journal of Thoracic and Cardiovascular SurgeryBilateral internal mammary artery grafting in diabetics: Outcomes, concerns and controversies
2015, International Journal of Surgery