Routine use of bilateral internal mammary artery grafts for myocardial revascularization in diabetic patients: a propensity score matched study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHONG Zhaoji , ZHENG Zhe ,  WANG Xiaoqi , GAO Ge , LI Linlin , FAN Hongguang , LI Haojie

Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science, Beijing, 100037, P.R.China;

Corresponding author：

WANG Xiaoqi, Email: wxqfwn@163.com

Keywords：

Coronary artery bypass graft; bilateral internal mammary artery; diabetes

DOI：

10.7507/1007-4848.201801019

Video：

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Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.

Citation： ZHONG Zhaoji, ZHENG Zhe, WANG Xiaoqi, GAO Ge, LI Linlin, FAN Hongguang, LI Haojie. Routine use of bilateral internal mammary artery grafts for myocardial revascularization in diabetic patients: a propensity score matched study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(12): 1038-1042. doi: 10.7507/1007-4848.201801019 Copy

1.	Moshkovitz Y, Mohr R, Medalion B, et al. Drug-eluting stents compared with bilateral internal thoracic artery grafts for diabetic patients. Ann Thorac Surg, 2012, 94(5): 1455-1462.
2.	Taggart DP. The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease. Eur J Cardiothorac Surg, 2013, 44(6): 978-979.
3.	Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg, 2014, 46(4): 517-592.
4.	Kurlansky PA, Traad EA, Dorman MJ, et al. Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. Ann Thorac Surg, 2010, 90(1): 101-108.
5.	Lytle BW. Bilateral internal thoracic artery grafting. Ann Cardiothorac Surg, 2013, 2(4): 485-492.
6.	Gaudino M, Puskas JD, Di Franco A, et al. Three arterial grafts improve late survival: A meta-analysis of propensity-matched studies. Circulation, 2017, 135(11): 1036-1044.
7.	Dorman MJ, Kurlansky PA, Traad EA, et al. Bilateral internal mammary artery grafting enhances survival in diabetic patients: a 30-year follow-up of propensity score-matched cohorts. Circulation, 2012, 126(25): 2935-2942.
8.	Gatti G, Soso P, Dell'Angela L, et al. Routine use of bilateral internal thoracic artery grafts for left-sided myocardial revascularization in insulin-dependent diabetic patients: early and long-term outcomes. Eur J Cardiothorac Surg, 2015, 48(1): 115-120.
9.	Gansera B, Delalic A, Eszlari E, et al. 14-year results of bilateral versus single internal thoracic artery grafts for left-sided myocardial revascularization in young diabetic patients. Thorac Cardiovasc Surg, 2017, 65(4): 272-277.
10.	Chuah LL, Papamargaritis D, Pillai D, et al. Morbidity and mortality of diabetes with surgery. Nutr Hosp, 2013, 28(Suppl 2): 47-52.
11.	Lepelletier D, Bourigault C, Roussel JC, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect, 2013, 43(10): 403-409.
12.	Savage EB, Grab JD, O'Brien SM, et al. Use of both internal thoracic arteries in diabetic patients increases deep sternal wound infection. Ann Thorac Surg, 2007, 83(3): 1002-1006.
13.	Nakano J, Okabayashi H, Hanyu M, et al. Risk factors for wound infection after off-pump coronary artery bypass grafting: should bilateral internal thoracic arteries be harvested in patients with diabetes? J Thorac Cardiovasc Surg, 2008, 135(3): 540-545.
14.	仲肇基, 侯剑峰, 樊红光, 等. 骨骼化与带蒂获取双侧乳内动脉行冠状动脉旁路移植术早期临床结果的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(2): 128-132.
15.	畅怡, 王小啟, 郑哲, 等. 使用双侧乳内动脉行冠状动脉旁路移植术早期结果分析. 中国胸心血管外科临床杂志, 2017, 24(3): 206-210.
16.	Lytle BW, Blackstone EH, Loop FD, et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg, 1999, 117(5): 855-872.
17.	Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875.
18.	Yi G, Shine B, Rehman SM, et al. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation, 2014, 130(7): 539-545.
19.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): e652-e735.
20.	Ghanta RK, Kaneko T, Gammie JS, et al. Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(2): 364-372.
21.	Yan BP, Clark DJ, Buxton B, et al. Clinical characteristics and early mortality of patients undergoing coronary artery bypass grafting compared to percutaneous coronary intervention: insights from the Australian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventi. Heart Lung Circ, 2009, 18(3): 184-190.
22.	Gatti G, Perrotti A, Reichart D, et al. Glycated hemoglobin and risk of sternal wound infection after isolated coronary surgery. Circ J, 2016, 81(1): 36-43.
23.	Rollins KE, Varadhan KK, Dhatariya K, et al. Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus. Clin Nutr, 2016, 35(2): 308-316.

1. Moshkovitz Y, Mohr R, Medalion B, et al. Drug-eluting stents compared with bilateral internal thoracic artery grafts for diabetic patients. Ann Thorac Surg, 2012, 94(5): 1455-1462.
2. Taggart DP. The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease. Eur J Cardiothorac Surg, 2013, 44(6): 978-979.
3. Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg, 2014, 46(4): 517-592.
4. Kurlansky PA, Traad EA, Dorman MJ, et al. Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. Ann Thorac Surg, 2010, 90(1): 101-108.
5. Lytle BW. Bilateral internal thoracic artery grafting. Ann Cardiothorac Surg, 2013, 2(4): 485-492.
6. Gaudino M, Puskas JD, Di Franco A, et al. Three arterial grafts improve late survival: A meta-analysis of propensity-matched studies. Circulation, 2017, 135(11): 1036-1044.
7. Dorman MJ, Kurlansky PA, Traad EA, et al. Bilateral internal mammary artery grafting enhances survival in diabetic patients: a 30-year follow-up of propensity score-matched cohorts. Circulation, 2012, 126(25): 2935-2942.
8. Gatti G, Soso P, Dell'Angela L, et al. Routine use of bilateral internal thoracic artery grafts for left-sided myocardial revascularization in insulin-dependent diabetic patients: early and long-term outcomes. Eur J Cardiothorac Surg, 2015, 48(1): 115-120.
9. Gansera B, Delalic A, Eszlari E, et al. 14-year results of bilateral versus single internal thoracic artery grafts for left-sided myocardial revascularization in young diabetic patients. Thorac Cardiovasc Surg, 2017, 65(4): 272-277.
10. Chuah LL, Papamargaritis D, Pillai D, et al. Morbidity and mortality of diabetes with surgery. Nutr Hosp, 2013, 28(Suppl 2): 47-52.
11. Lepelletier D, Bourigault C, Roussel JC, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect, 2013, 43(10): 403-409.
12. Savage EB, Grab JD, O'Brien SM, et al. Use of both internal thoracic arteries in diabetic patients increases deep sternal wound infection. Ann Thorac Surg, 2007, 83(3): 1002-1006.
13. Nakano J, Okabayashi H, Hanyu M, et al. Risk factors for wound infection after off-pump coronary artery bypass grafting: should bilateral internal thoracic arteries be harvested in patients with diabetes? J Thorac Cardiovasc Surg, 2008, 135(3): 540-545.
14. 仲肇基, 侯剑峰, 樊红光, 等. 骨骼化与带蒂获取双侧乳内动脉行冠状动脉旁路移植术早期临床结果的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(2): 128-132.
15. 畅怡, 王小啟, 郑哲, 等. 使用双侧乳内动脉行冠状动脉旁路移植术早期结果分析. 中国胸心血管外科临床杂志, 2017, 24(3): 206-210.
16. Lytle BW, Blackstone EH, Loop FD, et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg, 1999, 117(5): 855-872.
17. Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875.
18. Yi G, Shine B, Rehman SM, et al. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation, 2014, 130(7): 539-545.
19. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): e652-e735.
20. Ghanta RK, Kaneko T, Gammie JS, et al. Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(2): 364-372.
21. Yan BP, Clark DJ, Buxton B, et al. Clinical characteristics and early mortality of patients undergoing coronary artery bypass grafting compared to percutaneous coronary intervention: insights from the Australian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventi. Heart Lung Circ, 2009, 18(3): 184-190.
22. Gatti G, Perrotti A, Reichart D, et al. Glycated hemoglobin and risk of sternal wound infection after isolated coronary surgery. Circ J, 2016, 81(1): 36-43.
23. Rollins KE, Varadhan KK, Dhatariya K, et al. Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus. Clin Nutr, 2016, 35(2): 308-316.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Routine use of bilateral internal mammary artery grafts for myocardial revascularization in diabetic patients: a propensity score matched study

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