Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes mellitus

Abstract

BITA grafting with complete revascularization maximizes long-term survival and is recommended for patients with diabetes undergoing CABG. BITA grafting should be used in all patients with diabetes whose risk of DSWI is low. It might be best avoided in obese diabetic women with diffuse atherosclerotic burden-those at greatest risk of developing these infections.

Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus

“…13 Despite the marked long-term benefits of BITA grafting, one of the concerns regarding its use is postoperative DSWI. [26][27][28][29] In the present study, the overall rate of DSWI was acceptable (1.4%), but it was significantly higher in the HD group. This rate, however, was similar to those of previous reports including HD cohorts.…”

“…These results, however, should not be directly applied to other races because obesity is also a known risk factor for DSWI, and the mean BMI of Japanese study subjects, including that in the present study, was around 23 kg/m 2 , 16,23-25 while that in the US was 27-30 kg/m 2 . 13,14, 26 With regard to long-term results, CKD severity was strongly correlated with overall survival, cardiac death, and MACCE among DM patients. Severe CKD with or without HD was associated with a markedly high HR for overall death, but the exact mechanism of the association between CKD and death after CABG remains unclear.…”

“…The long-term benefits of BITA grafting in DM patients with multivessel disease have already been shown. [26][27][28][29] As for BITA grafting in CKD patients, the efficacy of BITA grafting is one of the concerns when treating patients with markedly impaired renal function. 31, 32 Kinoshita et al noted superior midterm results for skeletonized BITA grafting as compared with SITA grafting in patients with CKD.…”

Right internal thoracic artery or radial artery? A propensity-matched comparison on the second-best arterial conduit

“…This result is supported a recent 5- Although in this low risk population, operative complication were particularly low in both groups, the use of RITA was associated6 with an increased surgical morbidity Taking into account the observed increased operative morbidity associated with the RITA may be delayed by as much as 7 to 10 years [30], it seems reasonable to consider the RA as a valid option in older patients or patients with greater number of risk factors such as diabetes, obesity [31].…”

Bilateral versus Single Internal-Thoracic-Artery Grafts

“…This benefit has been shown to be further improved by the use of arterial graft vessels [37]. The main concern over BITA grafting is likely fear of SWI, and considering that diabetes is a known risk factor for SWI, the use of BITA grafting in this patient category has been ambiguous [38].…”