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Bilateral internal mammary grafts in diabetics: benefits outweigh perioperative risks
Patients with diabetes have more severe coronary disease at presentation and worse overall outcomes than their non-diabetic counterparts, even following surgical revascularisation. Whilst use of the left internal thoracic artery is well established and improves event free survival when anastomosed to the LAD, the use of both right and left internal thoracic arteries in bilateral (BITA) grafting is less well described with concerns remaining over the associated increased risks of sternal wound infection, particularly in diabetics.
In this single-centre, retrospective, registry study, patients undergoing BITA grafting between 1996 and 2006 were studied. A total of 69 patients with insulin-treated diabetes and 732 with orally treated diabetes received isolated skeletonised BITA grafts. Of these patients, 338 were younger than 65 years, 322 were between 65 and 74 years old, and 141 were 75 years or older. Operative mortality was lower than logistic EuroSCORE-calculated mortality (2.9% vs 7%, p<0.001). Predictors of increased mortality were critical preoperative …
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