CLINICAL STUDIES
Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients
Takashi Hirotani, MDa,
Tadashi Kameda, MDa,
Takayuki Kumamoto, MDa,
Shogo Shirota, MDa and
Mototugu Yamano, MDa
a Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
Manuscript received November 2, 1998;
revised manuscript received March 10, 1999,
accepted April 21, 1999.
Reprint requests and correspondence: Dr. Takashi Hirotani, Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, 1-7-14 Mita, Minato-ku, Tokyo 108-0073, Japan
OBJECTIVES
In our institute, internal mammary arteries (IMAs) have been preferred for coronary artery bypass grafting (CABG) in diabetic patients. The purpose of this study was to evaluate the influence of diabetes and IMA grafting on survival after CABG.
BACKGROUND
The influence of diabetes on the results of CABG is not well documented, and there is controversy about whether the use of IMAs conveys greater survival benefits to diabetic patients.
METHODS
A total of 420 consecutive patients who underwent CABG from April 1990 to July 1998 were reviewed; 211 of these patients had diabetes mellitus at the time of surgery. Internal mammary artery grafts have been used with increasing frequency, and bilateral IMAs have been used when possible since 1993. Internal mammary artery grafts were used in 164 nondiabetic patients (78%) and in 155 diabetic patients (73%). Seventy-eight nondiabetic patients and 74 diabetic patients received bilateral IMA grafts.
RESULTS
The postoperative mortality was 2.4% in the nondiabetic and 2.8% in the diabetic group. With regard to postoperative complications, diabetic patients had a significantly higher rate of chest wound infection (p < 0.05), irrespective of whether IMAs were used or not. The use of bilateral IMAs did not increase the risk of chest wound infection in nondiabetic or diabetic patients. Overall survival curve, cardiac deathfree curve and cardiac eventfree curve were not affected adversely by diabetes, and in diabetic patients, CABG with saphenous veins alone conveyed significantly (p < 0.01) less long-term benefit than did CABG with at least one IMA graft.
CONCLUSIONS
It was suggested that IMA grafts should be preferred in diabetic patients.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass grafting | | IMA | = internal mammary artery |
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