Abstract 10220: Long Term Outcome of Diabetic Patients Undergoing Bilateral Internal Thoracic Artery Grafting
Objectives: Although BITA is associated with improved survival, the use of this technique in diabetics is controversial due to the increased risk of sternal infection. On the other hand, diabetic patients may benefit from BITA grafting due to their accelerated atherosclerosis and the increased propensity for saphenous vein graft failure. The purpose of this study is to evaluate pre-operative and operative factors affecting early and long-term outcome in order to better select diabetic patients for BITA grafting.
Methods: Between 1996 and 2006, 57 insulin treated and 685 oral treated diabetic patients underwent isolated skeletonized BITA grafting. There were 562 males and 180 females. 313 were younger than 65 years of age, 304 were between 65 and 74 and 127 were 75 or older.
Results: The actual early mortality was lower than the logistic “Euroscore” calculated mortality (3.8% vs. 6.4%, P=0.022). Increased mortality was observed in patients with Peripheral Vascular Disease (PVD) (8.1% vs. 2.9% without PVD. P=0.011). Early post-operative morbidity included sternal infection (3.8%), cerebro-vascular accident (1.7%) and peri-operative myocardial infarction (0.4%). Multivariate correlates of sternal infection were: repeat operation (P<0.001), COPD (P=0.002) and PVD (P=0.012). Mean follow-up was 8.4±4 years. The Kaplan-Meier 10-year survival rates for patients <65, 65-74, and >75 years of age were 76.4%, 62.4%, and 38.6%, respectively (P<0.001). They were better than the corresponding predicted Charlson Comorbodity Index survivals (57.5%, 26.3%, and 11.1% respectively. P<0.0001 for all age groups). Predictors of decreased survival were age (HR 1.05, 95% CI 1.04-1.07), CHF (HR 2.44, 95% CI 1.92-3.10) and PVD (HR 1.78, 95% CI 1.37-2.33).
Conclusions: BITA grafting in diabetic patients is safe. The favorable short and long-term outcome outweighs the adverse effect of sternal infection.
- © 2011 by American Heart Association, Inc.