Aya Mohr1, Dmitry Pevni1, Gideon Uretzky1, Itzhak Shapira1, Amir Kramer1, Yosef Paz1, Benjamin Medalion2, Rephael Mohr1.
1Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel, 2Rabin Medical Center - Beilinson Campus, Petah Tikva, Israel.
OBJECTIVE:
Skeletonized dissection of the Internal Thoracic Arteries (ITA) improves sternal blood flow and thus reduces the risk of sternal infection in patients undergoing bilateral ITA grafting. Skeletonized harvesting of two ITAs was routinely used in our center also for patients with increased risk of infection. This report describes the long-term outcome of the subset of diabetic patients treated with BITA grafting.
METHODS:
From 1996 to 2001, 515 consecutive diabetic patients underwent BITA grafting in our center. There were 368 males and 148 females; 218 (42.3%) were older than 70 years, 37 (7.2%) were insulin-treated diabetics and the remaining 488 were orally-treated diabetics. Sixty (11.6%) were emergency cases, 113 (22%) had acute myocardial infarction (MI), 140 (22.7%) had congestive heart failure (CHF) and 89 (17.3%) had peripheral vascular disease (PVD). 77.4% of the patients were operated on with cardio-pulmonary bypass and 116 (22.5%) without (OPCAB).
RESULTS:
Mean number of grafts per patient was 3.1. Early mortality was 3.7% (8.3% in emergency cases and 3% for non-emergency cases, p<0.03. Sternal infection occurred in 3.1% of the patients (1.8% for off-pump and 3.7% for on-pump patients). Follow-up ranged between 6 and 11 years, mean 8.5 years. Five and ten year actuarial (KM) survival for patients younger than 65 was 90.7% and 80.1%, respectively; for patients between 65-74 it was 79.6% and 66% and for patients 75 years and older 66% and 48%, respectively. Older age H.R. 4.88 (95% CI 2.24-10.50), COPD H.R. 2.8 (95% CI 1.62-4.83), CHF H.R. 1.77 (95% CI 1.25-2.5) and PVD H.R. 1.53 (95% CI 1.02-2.28) were independent predictors of decreased survival. OPCAB was found to be associated with better survival - H.R. 0.57 (95% CI 0.35-0.93).
CONCLUSIONS:
Early and mid-term outcome of skeletonized BITA grafting for patients with diabetes mellitus is good. Long-term results are better for the younger age group and for OPCAB patients.
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