Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients

Background. There is a tendency to avoid the bilateral internal thoracic artery (ITA) grafting in diabetics. However, we no longer consider diabetes a reason for excluding the bilateral use of ITAs. We compare the early and long-term results in diabetic cases treated by coronary artery bypass grafting (CABG) using unilateral and bilateral ITA grafts. Methods. A total of 303 consecutive diabetic cases of CABG using ITA grafts between April 1991 and January 2003 were reviewed. Of these, 149 (49%) were being treated with insulin. The cases were divided into two groups: 179 cases in which bilateral ITA grafts had been used and 124 in which a unilateral ITA graft had been used. Results. The mortality for the bilateral ITA group and unilateral ITA group were 1.7% and 1.6%, respectively. The fact that patients were receiving insulin had no effect on the mortality of CABG. A review of morbidity revealed that no differences were found between the two groups. The survival curves, cardiac-death-free curves, and cardiac-event-free curves showed that there was no difference between the use of one or two ITA grafts in diabetics, while bilateral use of ITA grafts was significantly better than unilateral use in a comparable group of nondiabetics operated during the same time period. Conclusions. There was no significant difference in operative mortality related to single or double ITA grafting in diabetics. There was also no difference between the use of one or two ITA grafts in diabetics in regard to long-term follow-up. (C) 2003 by The Society of Thoracic Surgeons.