Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

Endo, Masahiro; Tomizawa, Yasuko; Nishida, Hiroshi

doi:10.1161/01.cir.0000085995.87982.6e

Cited by 78 publications

(49 citation statements)

References 30 publications

(30 reference statements)

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“…Similar results have been previously reported in smaller groups of patients with a shorter duration of follow-up. [17][18][19] Unlike those reports, the survival benefit observed here did not appear to be influenced by patient age at the time of surgery. 20 The absence of significant difference in the SWI rate among BIMA patients may represent a type II error that could have become significant with a larger cohort of patients.…”

Section: Discussioncontrasting

confidence: 89%

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Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

et al. 2012

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Background— The prevalence of diabetes mellitus is increasing at an unprecedented rate, affecting nearly 8% of the population. Previous studies have demonstrated a potential benefit for surgical over interventional revascularization in this group of patients. Similarly, studies have shown the superiority of bilateral internal mammary artery (BIMA) grafting over single internal mammary artery (SIMA) grafting in select populations. However, concerns about sternal wound infection have discouraged the use of BIMA grafting in diabetics. Therefore, we studied the long-term results of BIMA versus SIMA grafting in a large population of diabetic patients in whom BIMA grafting was broadly applied. Methods and Results— Between February 1972 and May 1994, 1107 consecutive diabetic patients underwent coronary artery bypass grafting with either SIMA (n=646) or BIMA (n=461) grafting. Optimal matching with the propensity score was used to create matched SIMA (n=414) and BIMA (n=414) cohorts. Cross-sectional follow-up (6 weeks to 30.1 years; mean, 8.9 years) determined long-term survival. There was no difference in operative mortality, sternal wound infection, or total complications between matched SIMA and BIMA groups (operative mortality, 10 of 414 [2.4%] versus 13 of 414 [3.1%]; P =0.279; sternal wound infection, 7 of 414 [1.7%] versus 13 of 414 [3.1%]; P =0.179); total complications, 71 of 414 [17.1%] versus 71 of 414 [17.1%]; P =1.000). Late survival was significantly enhanced with the use of BIMA grafting (median survival: SIMA, 9.8 years versus BIMA, 13.1 years; P =0.001). Use of BIMA was found to be associated with late survival on Cox regression ( P =0.003). Conclusion— Compared with SIMA grafting, BIMA grafting in propensity score–matched patients provides diabetics with enhanced survival without any increase in perioperative morbidity or mortality.

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Section: Discussioncontrasting

confidence: 89%

“…Have improvements in perioperative care and medical therapy ameliorated or even eliminated the survival benefits observed? More recent studies with both on-pump 19 and off-pump 17 CABG suggest that these results have been replicable in today's modern surgical era.…”

Section: Dorman Et Al Ima Grafting In Diabetic Patients 2939mentioning

confidence: 90%

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

et al. 2012

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“…BIMA use may increase the risk of sternal wound infection, 23,24 especially in patients with diabetes mellitus. 25 However, other studies have shown that the skeletonization technique reduces the risk of wound infection after BIMA use in diabetic patients 26 and that BIMA grafts provide some benefits even in diabetic patients. 26 The indications and contraindications are controversial.…”

Section: Discussionmentioning

confidence: 99%

“…25 However, other studies have shown that the skeletonization technique reduces the risk of wound infection after BIMA use in diabetic patients 26 and that BIMA grafts provide some benefits even in diabetic patients. 26 The indications and contraindications are controversial. However, considering the benefits on long-term outcomes, [7][8][9][10][11] BIMA grafts seem underused in the United States.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

et al. 2009

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“…This benefit is largely secondary to the use of internal thoracic artery grafts [8,18]. multiple arterial grafts seems to be favorable in these patients [19]. There is recent evidence showing that bilateral internal thoracic artery grafts provide benefits to the long-term survival, although there are no randomized studies to support such findings [20].…”

Section: Introductionmentioning

confidence: 99%

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus

Martins¹,

Santos²,

Tirado³

et al. 2007

Rev Bras Cir Cardiovasc

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Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitusCoronary artery bypass grafting using both internal mammary arteries in patients with diabetes mellitus Abstract Objective: We sought to describe the use of both internal thoracic arteries (ITA) in patients with diabetes mellitus (DM) submitted to a coronary artery bypass grafting (CABG).Method: Between January 1995 to August 2005, 4,569 patients received isolated CABG in our institution. Of the initial population, 1,298 had DM. The median age of the patients was 62 years and total mortality rate was 2.18% (100 patients). Both internal thoracic arteries were used in 700 patients. Patients were divided into two groups: with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double ITA grafting was based on coronary artery anatomy and on the quality of sternum. The later was evaluated during the sternal transsection. When these two factors were considered favorable, we have both ITAs dissected, regardless whether the patient had DM. During the dissection of both internal thoracic arteries, one must take care not to open the pleural spaces.Results: There was a small difference between the two groups in terms of morbidity and mortality.Conclusion: Our data suggests that patients with DM can benefit with the efficient use of both internal thoracic arteries with a small increase in the risk of complications, if its application is carefully indicated.

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Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

Cited by 78 publications

References 30 publications

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

Bilateral Internal Mammary Artery Grafting Enhances Survival in Diabetic Patients

Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus

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