Complete arterial revascularization using T-graft technique in diabetics with coronary three-vessel disease.

Abstract

Coronary revascularization using exclusively arterial grafts holds the promise of improved long-term patency. The T-graft approach achieves this goal with only two arterial grafts in coronary 3-vessel disease. Arterial grafts in diabetics, however, exhibit more frequently atherosclerotic wall abnormalities, and higher levels of endothelin-1 were found in diabetic arterial grafts, which may be associated with a higher incidence of vasoconstriction. The objective of this prospective study was to compare functional und angiographic parameters of arterial T-grafts in diabetics and nondiabetics. Coronary angiography was performed consecutively in 20 patients with insulin-dependent diabetes mellitus (IDDM), 20 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 100 non-diabetics one week after complete arterial revascularization with T-grafts. Graft patency was assessed, and the diameter of the proximal left internal mammary artery (IMA) graft was measured using quantitative coronary analysis. Absolute flow volume in the proximal left IMA was measured using the flow-wire technique at baseline and after an adenosine injection into the graft to induce maximal hyperemia. Coronary flow reserve (CFR) was calculated as the ratio of maximal to baseline flow. There was no difference between patients with IDDM, patients with NIDDM and non-diabetics with respect to patency (98.3% vs. 98.8% vs. 97,8%, n.s.), graft lumen diameter (3.42 +/- 0.48 vs. 3.36 +/- 0.50 vs. 3.38 +/- 0.41 mm, n.s.), baseline flow (78.4 +/- 34.3 vs. 83.1 +/- 36.6 vs. 81.5 +/- 39.0 ml/min, n.s.), and CFR (1.85 +/- 0.37 vs. 1.89 +/- 0.44 vs. 1.90 +/- 0.40, n.s.). Baseline parameters (graft diameter and quantitative graft flow), patency and CFR are identical in diabetics and non-diabetics. Our results suggest that diabetic patients with coronary 3-vessel disease take comparable profit from complete arterial revascularization using the T-graft technique as non-diabetics.