Does bilateral internal thoracic artery grafting increase surgical risk indiabetic patients?

Background. The purpose of this study was to determine whether, with approp riate techniques, diabetic patients could benefit from the advantages of do uble internal thoracic artery (ITA) coronary bypass without an increased ho spital risk. Methods. Between January 1990 and December 1996, 207 consecutive diabetic p atients underwent coronary artery bypass graft operations. In 74 patients b oth arteries (bilateral ITA group) were used, whereas 133 patients received one ITA and vein grafts or vein grafts alone (nonbilateral group). Patient s in the bilateral ITA group were younger (p < 0.0001), predominantly male (p < 0.0001), acid were operated on more electively. The internal thoracic arteries were harvested by skeletonization without electrocautery, and stri ct glycemic control was pursued. Results. NO death was observed in the bilateral ITA group, whereas 7 patien ts died in the nonbilateral ITA group (p < 0.05). Deep sternal wound infect ion was observed in 2 patients in the nonbilateral ITA group (1.5%) and in none of the bilateral ITA group (p = NS). There was no significant differen ce in the morbidity rate between the two groups except for greater blood lo sses in the bilateral ITA group. Conclusion. Double ITA coronary revascularization in young diabetic patient s was performed without increased morbidity and mortality. The low rate of sternal wound infections may be related to ITA harvesting by a skeletonizat ion technique, but larger studies are required to confirm these data. (C) 1 998 by The Society of Thoracic Surgeons.