Bilateral Internal Thoracic Artery Grafting in Insulin-treated Diabetic Subsets

Background: Insulin-treated diabetics may benefit the most from bypass grafts most resistant to the enhanced diabetes-related vascular process. While increasing data suggests that skeletonized bilateral internal thoracic artery (BITA) grafting can be safely implemented in oral-treated subsets, the feasibility of this approach in insulin-treated diabetics remains undetermined.

Methods: The data of 283 insulin-treated diabetic patients undergoing BITA grafting between 2006 and 20015 were analyzed. BITA were invariably skeletonized.

Results: Mean age was 61 ± 9.4 years. Female gender comprised 18%. BITA only and BITA with radial artery (RA) grafting was achieved in 30% and 55.4% of patients (complete revascularization in 85.4%). BITA with saphenous vein (with or without RA) was performed in the remaining patients (14.5%). The mean number grafts per patient, arterial grafts/patient and ITA grafts/patient was 3.9 ± 0.4 and 3.7 + 0.2 and 2.9 ± 0.2, respectively. In-situ BITA grafting was performed in 61% of patients. The distribution of configurations was T-grafting (37.1%) left-sided retroaortic right ITA (RITA) (31.7%), classic RITA to right system (14.5%), left-sided anteaortic RITA (13.8%), and free RITA (1.1%). Overall, 30-day mortality was 1.7%. The respective rate of neurological events and re-exploration for bleeding was 1.1% and 1.4%. Derived from predetermined treatment-protocol early administration of intravenous antibiotics was documented in16.9% (n=48) for any non-specific sternal secretion. However, vaccum-assisted drainage (VAC) and sternoplasty were required in 1.4% (n=4) and 0.4 % (n=1) of patients, respectively.

Conclusions: Skeletonized BITA grafting can be performed at acceptable risk in eligible insulin-treated diabetics and should be favorably considered. Patient eligibility-criteria, strict postoperative anti-glycemic protocol and aggressive early antibiotic treatment are recommended.