Are Two Skeletonized Internal Thoracic Artery Grafts Better than one in Patients with Insulin Dependent Diabetes ?

Objectives: .The purpose of this study is to compare early and long-term outcome of bilateral ITA(BITA) grafting to that of single ITA and other conduits such as saphenous veins(SVG) and radial artery (RA) in IDDM patients with multi-vessels disease.

Methods: Seventy nine IDDM patients who underwent BITA grafting between 1996 and 2008 were compared with 144 who underwent CABG with SITA and SVG or RA

Results . Patients undergoing SITA were more often females and more likely to have unstable angina .Their. Logistic Euroscre was significantly higher(12,9 vs. 6.9, p< 0.001 )

Operative mortality (2.5 % vs.4.9%, in the BITA and SITA groups ,respectively) and occurrence SWI( 5.1 % vs. 6,3%,) in the two groups were similar . There were six revisions for bleeding (4.3%) in the SITA group compared to 1(1.3%) in the BITA group(p= 0.123)

Mean follow-up was 11 .6 (95%CI 10.1-13.9)years .

Kaplan Meier 10 years survival of BITA patients was better (60.2% vs.50.3% p<0.001) .However , the difference in propensity- adjusted survival did not reach statistical significance (HR 0.818 p=0.358)(COX model)

When early post operative ,.morbidity events were entered in to the cox model , sternal infection( HR 3.347 , p=0.04) and revision(HR 2.778 p= 0.028) emerged as predictors of decreased survival. Number of bypass grafts 3 or more was associated with improved survival.(HR 0.429 p=0.028)

Conclusion: This study suggests that long-term outcome of arterial revascularization with BITA in IDDM patients is not better than that of SITA .. Despite the use skeletonizing dissection , BITA grafting in IDDM patients was associated with increased risk of SWI and decreased survival ,however those risks cannot be reduced by SITA grafting.