14- Year- Results of Bilateral versus Single Internal Thoracic Artery Grafts for Left-sided Myocardial Revascularization in Young Diabetic Patients

Objectives: Despite encouraging late outcomes, the use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization in diabetic patients remains controversial because of an increased risk of sternal complications. In the present study, early and longterm outcomes of BITA- versus single internal thoracic artery (SITA)- grafting in young (< 65 years of age) diabetic patients were reviewed retrospectively. Methods: 250 propensity score pair-matched diabetic patients, (exclusively 30-day survivors) operated on between February 2000 and December 2011,receiving either BITA ( n = 125, Gr A) or SITA ( n = 125, Gr B) grafting were analyzed retrospectively. In each group 104 pts were males, mean age was 60.1 ± 5.3 years. EF > 50% was 63.2 versus 67.2% ( p = 0.595), elective operations were performed in 94.4 versus 92.0% ( p = 0.617). Follow up was 2.1 to 14.8 years (mean 9.3 ± 3.5 years) and was complete for 100%. Results: Incidence of deep sternal wound infection was 2.4 versus 3.2% ( p = 0.722). Rethoracotomy due to bleeding occurred in 4.8 versus 3.2% ( p = 0.608). The 5-, 10- and 14-year estimates of survival were 93.4(95% CI: 91.1- 99.7), 76.6 (95% CI:71.76.- 87.7)and 67.5% (95%CI:53.0–85.2),(Gr A) versus 89.5 (95%CI: 86.5–97.4), 81.5 (95%CI:76.9–92.6) and 32.8% (95%CI:5.38- 71.2) (Gr B); p = 0.288. Freedom from re-angiography / intervention (60.5 versus 63.9%) during follow up was comparable ( p = 0.507) as well as infarction rate (93.8versus 95.1%, p = 0.833) and redoes ( p = 0.672, exclusively valve surgery) were. Freedom from thromboembolic or cerebrovascular events did not show a significant differences (94.0 versus 94.0%, p = 0.78). Multivariate analysis identified poor ejection fraction as a predictor for decreased late survival. Age, gender or urgency had no influence on long-term mortality. Conclusions: Left-sided BITA grafting may be performed routinely in diabetic patients without increased incidence of postoperative wound-healing complications. Survival rates after 5, 10 and 14 show no advantage for BITA- to SITA-grafting.