Giuseppe Gatti1, Luca Dell'Angela2, Luca Maschietto3, Roberto Luzzati4, Gianfranco Sinagra2, Aniello Pappalardo3. 1. Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy. Electronic address: gius.gatti@gmail.com. 2. Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy. 3. Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy. 4. Division of Infective Diseases, Ospedali Riuniti and University of Trieste, Trieste, Italy.
Abstract
BACKGROUND: Increased risk of postoperative complications limits use of bilateral internal thoracic artery (BITA) grafting in diabetic patients. The authors' experience in routine BITA grafting was reviewed to investigate the impact of diabetes on early outcomes. METHODS: Among the 4508 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery from January 1999 throughout August 2015, skeletonised BITA grafts were used in 3228 (71.6%) patients, 972 diabetic and 2256 non-diabetic. After one-to-one propensity score (PS)-matched analysis, 819 pairs of diabetic/non-diabetic patients were compared for postoperative outcomes. The operative risk was calculated for each patient according to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II). RESULTS: Although diabetic had higher risk profiles than non-diabetic patients both in unmatched (EuroSCORE II: 5.3±7.3% vs. 3±4.2%, p<0.0001) and PS-matched series (EuroSCORE II: 5.1±7.1% vs. 3.6±4.3%, p<0.0001), there were no differences in hospital mortality (2.2% vs. 1.8%, p=0.52 and 2.1% vs. 2.3%, p=0.74, respectively). In PS-matched pairs, the use of adrenergic agonists (p=0.03), postoperative bleeding (p=0.0055) and deep incisional sternal wound infection (p=0.0018) were more frequent in diabetic patients who had a mean of longer hospital stays (p=0.023). CONCLUSIONS: Bilateral internal thoracic artery grafting may be routinely performed even in diabetic patients despite higher risk profiles. Increased postoperative complications prolong hospital stay but do not impact on early mortality.
BACKGROUND: Increased risk of postoperative complications limits use of bilateral internal thoracic artery (BITA) grafting in diabeticpatients. The authors' experience in routine BITA grafting was reviewed to investigate the impact of diabetes on early outcomes. METHODS: Among the 4508 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery from January 1999 throughout August 2015, skeletonised BITA grafts were used in 3228 (71.6%) patients, 972 diabetic and 2256 non-diabetic. After one-to-one propensity score (PS)-matched analysis, 819 pairs of diabetic/non-diabeticpatients were compared for postoperative outcomes. The operative risk was calculated for each patient according to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II). RESULTS: Although diabetic had higher risk profiles than non-diabeticpatients both in unmatched (EuroSCORE II: 5.3±7.3% vs. 3±4.2%, p<0.0001) and PS-matched series (EuroSCORE II: 5.1±7.1% vs. 3.6±4.3%, p<0.0001), there were no differences in hospital mortality (2.2% vs. 1.8%, p=0.52 and 2.1% vs. 2.3%, p=0.74, respectively). In PS-matched pairs, the use of adrenergic agonists (p=0.03), postoperative bleeding (p=0.0055) and deep incisional sternal wound infection (p=0.0018) were more frequent in diabeticpatients who had a mean of longer hospital stays (p=0.023). CONCLUSIONS: Bilateral internal thoracic artery grafting may be routinely performed even in diabeticpatients despite higher risk profiles. Increased postoperative complications prolong hospital stay but do not impact on early mortality.