Coronary Artery Bypass Revascularization Using Bilateral Internal Thoracic Arteries in Diabetic Patients: A Systematic Review and Meta-Analysis
2015; Elsevier BV; Volume: 99; Issue: 3 Linguagem: Inglês
10.1016/j.athoracsur.2014.09.045
ISSN1552-6259
AutoresKan Kajimoto, Taira Yamamoto, Atsushi Amano,
Tópico(s)Cardiac Valve Diseases and Treatments
ResumoThis study examined the effect of coronary artery bypass graft surgery with bilateral internal thoracic artery grafting in diabetic patients. Coronary artery bypass graft surgery using skeletonized bilateral internal thoracic artery grafts was not associated with an increased risk of deep sternal wound infection or early death. Moreover, patients who underwent coronary artery bypass graft surgery using bilateral internal thoracic artery grafting had lower remote mortality and cardiac mortality. We conclude that coronary artery bypass surgery using bilateral internal thoracic artery grafts is an excellent strategy, even for diabetic patients. This study examined the effect of coronary artery bypass graft surgery with bilateral internal thoracic artery grafting in diabetic patients. Coronary artery bypass graft surgery using skeletonized bilateral internal thoracic artery grafts was not associated with an increased risk of deep sternal wound infection or early death. Moreover, patients who underwent coronary artery bypass graft surgery using bilateral internal thoracic artery grafting had lower remote mortality and cardiac mortality. We conclude that coronary artery bypass surgery using bilateral internal thoracic artery grafts is an excellent strategy, even for diabetic patients. The Appendix Figure 1 can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2014.09.045] on http://www.annalsthoracicsurgery.org. Coronary artery bypass graft surgery (CABG) is the coronary revascularization strategy of choice for patients with multivessel coronary artery disease [1Mohr F.W. Morice M.C. Kappetein A.P. et al.Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.Lancet. 2013; 23: 629-638Abstract Full Text Full Text PDF Scopus (1238) Google Scholar]. Nevertheless, diabetes mellitus remains a strong risk factor for mortality and morbidity after CABG [2Kajimoto K. Kasai T. Miyauchi K. et al.Metabolic syndrome predicts 10-year mortality in non-diabetic patients following coronary artery bypass surgery.Circ J. 2008; 72: 1481-1486Crossref PubMed Scopus (41) Google Scholar, 3Farkouh M.E. Domanski M. Sleeper L.A. et al.Strategies for multivessel revascularization in patients with diabetes.N Engl J Med. 2012; 367: 2375-2384Crossref PubMed Scopus (1367) Google Scholar, 4Alserius T. Hammar N. Nordqvist T. et al.Improved survival after coronary artery bypass grafting has not influenced the mortality disadvantage in patients with diabetes mellitus.J Thorac Cardiovasc Surg. 2009; 138: 115-122Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar]. In the acute postoperative phase, diabetes is associated with an increased risk of infection due to hyperglycemia, relative immunodeficiency, and microcirculatory insufficiency [5Furnary A.P. Zerr K.J. Grunkemeier G.L. et al.Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.Ann Thorac Surg. 1999; 67: 352-360Abstract Full Text Full Text PDF PubMed Scopus (1025) Google Scholar]. Over the long term after CABG, diabetes is associated with an increased risk of death, cardiac death, and other adverse events as a result of a propensity toward severe atherosclerosis due to prothrombotic and proinflammatory states [4Alserius T. Hammar N. Nordqvist T. et al.Improved survival after coronary artery bypass grafting has not influenced the mortality disadvantage in patients with diabetes mellitus.J Thorac Cardiovasc Surg. 2009; 138: 115-122Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar]. Meanwhile, CABG with internal thoracic artery (ITA) grafts can produce excellent outcomes, and the use of a left internal thoracic artery (LITA) to left anterior descending coronary artery graft, in particular, is associated with excellent long-term survival and a reduction in cardiac events due to graft patency; as a result, this strategy is the gold standard for CABG [6Hillis L.D. Smith P.K. Anderson J.L. et al.2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2011; 58: e123-e210Abstract Full Text Full Text PDF PubMed Scopus (596) Google Scholar]. Coronary artery bypass graft surgery with bilateral internal thoracic artery (BITA) grafts is also sometimes used and is associated with good outcomes in nondiabetic patients [7Tabata M. Grab J.D. Khalpey Z. et al.Prevalence and variability of internal mammary artery graft use in contemporary multivessel coronary artery bypass graft surgery: analysis of The Society of Thoracic Surgeons national cardiac database.Circulation. 2009; 15: 935-940Crossref Scopus (164) Google Scholar, 8Taggart D.P. D'Amico R. Altman D.G. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries.Lancet. 2001; 358: 870-875Abstract Full Text Full Text PDF PubMed Scopus (610) Google Scholar, 9Calafiore A.M. Di Giammarco G. Teodori G. et al.Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts.Eur J Cardiothorac Surg. 2004; 26: 542-548Crossref PubMed Scopus (49) Google Scholar]. In contrast, CABG with BITA in diabetic patients has historically been associated with a higher risk of deep sternal wound infection (DSWI) [10Gansera B. Schmidtler F. Gillrath G. et al.Does bilateral ITA grafting increase perioperative complications? Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass.Eur J Cardiothorac Surg. 2006; 30: 318-323Crossref PubMed Scopus (58) Google Scholar, 11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 13Tavolacci M.P. Merle V. Josset V. et al.Mediastinitis after coronary artery bypass graft surgery: influence of the mammary grafting for diabetic patients.J Hosp Infect. 2003; 55: 21-25Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 16Stevens L.M. Carrier M. Perrault L.P. et al.Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 281-288Crossref PubMed Scopus (59) Google Scholar, 17Momin A.U. Deshpande R. Potts J. et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg. 2005; 80: 1765-1772Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 18Toumpoulis I.K. Anagnostopoulos C.E. Balaram S. et al.Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?.Ann Thorac Surg. 2006; 81: 599-606Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 19Agrifoglio M. Trezzi M. Barili F. et al.Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate.J Cardiothorac Surg. 2008; 3: 35Crossref PubMed Scopus (17) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 21Puskas J.D. Sadiq A. Vassiliades T.A. et al.Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients.Ann Thorac Surg. 2012; 94: 710-716Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar, 22Konstanty-Kalandyk J. Piatek J. Rudzinski P. et al.Clinical outcome of arterial myocardial revascularization using bilateral internal thoracic arteries in diabetic patients: a single centre experience.Interact Cardiovasc Thorac Surg. 2012; 15: 979-983Crossref PubMed Scopus (11) Google Scholar] and is therefore avoided. However, several recent studies have suggested that CABG with BITA grafts after skeletonized ITA harvesting is not associated with an increased risk of wound infection among diabetic patients [12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar]. Thus, the goal of this study was to reexamine the safety and efficacy of CABG with BITA grafts after skeletonized ITA harvesting in diabetic patients. Database searches were performed in the first week of February 2014. The following sources were searched for studies comparing single internal thoracic artery (SITA) and BITA grafts for diabetic patients: MEDLINE through PubMed (from 1995 to August 2013), EMBASE, and the Cochrane Library database (Cochrane Central Register of Controlled Trials). The following MeSH subject headings were used: "coronary artery bypass," "diabetes," "single internal thoracic artery," "bilateral internal thoracic artery," "double internal thoracic artery," "single internal mammary artery," "bilateral internal mammary artery," and "double internal mammary artery." The clinicaltrials.gov website was also searched for trials comparing SITA and BITA grafts for diabetic patients. The references cited within all available articles were also reviewed to identify candidate studies. All titles and abstracts were downloaded to Zotero version 2.1 (Center for History and New Media of George Mason University, Fairfax, VA). Studies satisfying the following criteria were included in this systematic review: (1) studies comparing SITA and BITA grafts for diabetic patients; (2) studies evaluating postoperative DSWI, early mortality, or remote outcomes; and (3) studies published in peer-reviewed journals with full available text in English. Studies in which it was not possible to extract data from the published results, as well as studies that did not report appropriate outcomes, were excluded. The endpoints of this study were as follows: (1) DSWI; (2) early death; (3) long-term mortality; and (4) long-term cardiac mortality. Deep sternal wound infection was defined as DSWI or mediastinitis. Early death consisted of in-hospital or 30-day mortality. Long-term mortality and cardiac mortality were defined as the cumulative incidence of all-cause and cardiac death. Two reviewers (K.K. and T.Y.) independently assessed studies for inclusion criteria. The following information was extracted from each study: first author, year of publication, study design, loss to follow-up, age, sex, number of participants in each group (SITA and BITA), proportion of ITA skeletonization, proportion of off-pump CABG, number of grafts or distal anastomoses, and European System for Cardiac Operation Risk Evaluation (EuroSCORE). Reviewers extracted the following outcomes: DSWI, early mortality, long-term all-cause mortality, and long-term cardiac mortality. Outcome data are presented as count data. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement [23Liberati A. Altman D.G. Tetzlaff J. et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.Ann Intern Med. 2009; 18: W65-W94Google Scholar]. The endpoints of each study were analyzed using risk ratio (RR) with 95% confidence interval (CI). We conducted these meta-analyses only for studies that reported outcomes as count data; studies that reported outcomes as risk estimates (eg, hazard ratio and RR) were excluded from these analyses. Summary estimates were calculated by DerSimonian-Laird weights for the random effects model. Forest plots were then created for graphic presentation of clinical outcomes. The I2 statistic was calculated as a measure of the proportion of the overall variation attributable to between-study heterogeneity rather than chance. The I2 values of 25%, 50%, and 75% correspond to low, intermediate, and high levels of heterogeneity, respectively. The Cochran χ2 (Cochran Q) test was used to assess the between-study heterogeneity in different groups. Publication bias was assessed by Horbold-Egger statistics, with a p value of less than 0.05 indicating significant publication bias among the studies. The meta-analysis was conducted using StatsDirect software version 2.7.2 (StatsDirect, Greater Manchester, UK). A total of 104 relevant studies were captured in the initial search (Fig 1). After screening the abstracts of these studies, the full-length articles of 13 studies fulfilled the inclusion criteria (Table 1). All 13 studies evaluated DSWI, had sample sizes ranging from 81 to 2,445, and were retrospective studies [10Gansera B. Schmidtler F. Gillrath G. et al.Does bilateral ITA grafting increase perioperative complications? Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass.Eur J Cardiothorac Surg. 2006; 30: 318-323Crossref PubMed Scopus (58) Google Scholar, 11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 13Tavolacci M.P. Merle V. Josset V. et al.Mediastinitis after coronary artery bypass graft surgery: influence of the mammary grafting for diabetic patients.J Hosp Infect. 2003; 55: 21-25Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 16Stevens L.M. Carrier M. Perrault L.P. et al.Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 281-288Crossref PubMed Scopus (59) Google Scholar, 17Momin A.U. Deshpande R. Potts J. et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg. 2005; 80: 1765-1772Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 18Toumpoulis I.K. Anagnostopoulos C.E. Balaram S. et al.Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?.Ann Thorac Surg. 2006; 81: 599-606Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 19Agrifoglio M. Trezzi M. Barili F. et al.Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate.J Cardiothorac Surg. 2008; 3: 35Crossref PubMed Scopus (17) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 21Puskas J.D. Sadiq A. Vassiliades T.A. et al.Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients.Ann Thorac Surg. 2012; 94: 710-716Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar, 22Konstanty-Kalandyk J. Piatek J. Rudzinski P. et al.Clinical outcome of arterial myocardial revascularization using bilateral internal thoracic arteries in diabetic patients: a single centre experience.Interact Cardiovasc Thorac Surg. 2012; 15: 979-983Crossref PubMed Scopus (11) Google Scholar]. Of these, nine studies evaluated early death [11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 16Stevens L.M. Carrier M. Perrault L.P. et al.Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 281-288Crossref PubMed Scopus (59) Google Scholar, 17Momin A.U. Deshpande R. Potts J. et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg. 2005; 80: 1765-1772Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 18Toumpoulis I.K. Anagnostopoulos C.E. Balaram S. et al.Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?.Ann Thorac Surg. 2006; 81: 599-606Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 21Puskas J.D. Sadiq A. Vassiliades T.A. et al.Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients.Ann Thorac Surg. 2012; 94: 710-716Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar, 22Konstanty-Kalandyk J. Piatek J. Rudzinski P. et al.Clinical outcome of arterial myocardial revascularization using bilateral internal thoracic arteries in diabetic patients: a single centre experience.Interact Cardiovasc Thorac Surg. 2012; 15: 979-983Crossref PubMed Scopus (11) Google Scholar], eight studies evaluated long-term mortality [11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 16Stevens L.M. Carrier M. Perrault L.P. et al.Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 281-288Crossref PubMed Scopus (59) Google Scholar, 18Toumpoulis I.K. Anagnostopoulos C.E. Balaram S. et al.Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?.Ann Thorac Surg. 2006; 81: 599-606Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 21Puskas J.D. Sadiq A. Vassiliades T.A. et al.Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients.Ann Thorac Surg. 2012; 94: 710-716Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar], and five studies evaluated long-term cardiac mortality [11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar]. Propensity-score matched analysis was reported in four studies [15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 18Toumpoulis I.K. Anagnostopoulos C.E. Balaram S. et al.Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?.Ann Thorac Surg. 2006; 81: 599-606Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 21Puskas J.D. Sadiq A. Vassiliades T.A. et al.Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients.Ann Thorac Surg. 2012; 94: 710-716Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar]. Ten studies mentioned a pedicle or skeletonized ITA [10Gansera B. Schmidtler F. Gillrath G. et al.Does bilateral ITA grafting increase perioperative complications? Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass.Eur J Cardiothorac Surg. 2006; 30: 318-323Crossref PubMed Scopus (58) Google Scholar, 11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 16Stevens L.M. Carrier M. Perrault L.P. et al.Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 281-288Crossref PubMed Scopus (59) Google Scholar, 17Momin A.U. Deshpande R. Potts J. et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg. 2005; 80: 1765-1772Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 19Agrifoglio M. Trezzi M. Barili F. et al.Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate.J Cardiothorac Surg. 2008; 3: 35Crossref PubMed Scopus (17) Google Scholar, 20Kinoshita T. Asai T. Nishimura O. et al.Off-pump bilateral versus single skeletonized internal thoracic artery grafting in patients with diabetes.Ann Thorac Surg. 2010; 90: 1173-1179Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 22Konstanty-Kalandyk J. Piatek J. Rudzinski P. et al.Clinical outcome of arterial myocardial revascularization using bilateral internal thoracic arteries in diabetic patients: a single centre experience.Interact Cardiovasc Thorac Surg. 2012; 15: 979-983Crossref PubMed Scopus (11) Google Scholar]. Ten studies indicated the number of grafts or distal anastomoses [11Hirotani T. Nakamichi T. Munakata M. et al.Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients.Ann Thorac Surg. 2003; 76: 2017-2022Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 12Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 16: 1343-1349Crossref Scopus (65) Google Scholar, 14Lev-Ran O. Braunstein R. Nesher N. et al.Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis.Ann Thorac Surg. 2004; 77: 2039-2045Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 15Calafiore A.M. Di Mauro M. Di Giammarco G. et al.Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.Ann Thorac Surg. 2005; 80: 888-895Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 16Stevens L.M. Carrier M. Perrault L.P. et al.Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 281-288Crossref PubMed Scopus (59) Google Scholar, 17Momin A.U. Deshpande R. Potts J. et al.Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting.Ann Thorac Surg. 2005; 80: 1765-1772Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 18Toumpoulis I.K. Anagnostopoulos C.E. Balaram S. et al.Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?.Ann Thorac Surg. 2006; 81: 599-606Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 19Agrifogl
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