Should Diabetes Be a Contraindication to Bilateral Internal Mammary Artery Grafting?
Document Type
Article
Publication Date
3-1-2018
Institution/Department
Surgery, Cardiology
Journal Title
The Annals of thoracic surgery
MeSH Headings
Aged, Aged, 80 and over, Contraindications, Procedure, Coronary Artery Disease, Diabetes Complications, Female, Hospital Mortality, Humans, Internal Mammary-Coronary Artery Anastomosis, Length of Stay, Male, Middle Aged, Patient Selection, Postoperative Complications, Propensity Score, Retrospective Studies
Abstract
BACKGROUND: This study evaluates the influence of bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) grafting on postoperative morbidity and long-term survival among diabetic patients undergoing coronary artery bypass grafting (CABG).
METHODS: A multicenter, retrospective analysis of 47,984 consecutive CABGs performed from 1992 to 2014 at 7 medical centers was conducted. Among the study population, 1,482 CABGs with BIMA were identified, and 1,297 BIMA patients were propensity-matched to 1,297 SIMA patients. The study cohort for this analysis, drawn from matched data, included 430 diabetic patients: 217 SIMA and 213 BIMA. The primary endpoint was long-term survival. Secondary endpoints included postoperative morbidity, length of stay, and in-hospital mortality.
RESULTS: The median duration of follow-up was 9.3 (range, 4.3 to 13.9) years. Among propensity-matched diabetic patients, there was no significant difference in age, body mass index, or major baseline comorbidities. The groups were also well matched on the number of diseased coronary arteries and number of distal anastomoses performed. There was no difference in the rate of mediastinitis or sternal dehiscence (p = 0.503) or in-hospital mortality (p = 0.758) between groups. Both groups had a similar median length of stay of 5 (range, 4 to 7) days. Diabetic patients who received a BIMA had significantly improved long-term survival when compared with SIMA patients (hazard ratio 0.75 [95% confidence interval 0.57 to 0.98], p = 0.034).
CONCLUSIONS: Among diabetics undergoing CABG, use of BIMA grafting does not result in increased in-hospital morbidity or mortality and confers a long-term survival advantage when compared with SIMA grafting. Thus, diabetic patients should be considered for BIMA grafting more frequently.
ISSN
1552-6259
First Page
709
Last Page
714
Recommended Citation
Iribarne, Alexander; Westbrook, Benjamin M; Malenka, David J; Schmoker, Joseph D; McCullough, Jock N; Leavitt, Bruce J; Weldner, Paul W; DeSimone, Joseph; Kramer, Robert S; Quinn, Reed D; Olmstead, Elaine M; Klemperer, John D; Sardella, Gerald L; Ross, Cathy S; DiScipio, Anthony W; and Northern New England Cardiovascular Disease Study Group, "Should Diabetes Be a Contraindication to Bilateral Internal Mammary Artery Grafting?" (2018). Maine Medical Center. 1601.
https://knowledgeconnection.mainehealth.org/mmc/1601
