Is bilateral internal thoracic artery grafting in poorly controlled diabetic obese patients a contraindication? A single center pilot study

Abstract

BackgroundIn spite of substantial evidence supporting a long-term survival benefit with bilateral internal mammary artery (BIMA) grafts in CABG, this technique remains grossly underutilized worldwide. The incidence of deep sternal wound infection (DSWI) following BIMA harvest ranges from 0.6% to 4.2%. The high incidence of obesity and diabetes among Kuwait population encouraged us to study the incidence of DSWI among our patients with BIMA. Methods101 patients who underwent CABG procedure with BIMA use in Al-Dabbous Cardiac center, Al-Adan Hospital, Kuwait. Between June 2014 and December 2016, were included and analyzed retrospectively. Results92 patients included in our study were males (91.1%) and were 9 females (8.9%). 86 patients had HbA1c > 7% (85.2%). 20 patients (19.8%) had Body Mass Index (BMI) > 30. Of all studied patients, 12 patients (11.9%) had both BMI > 30 and HbA1c > 7. DSWI occurred in 3 patients (3%) out of the studied 101 patients, 2 of them had BMI > 30 and HbA1c > 7. The multi-variable analysis showed a significant correlation between the occurrence of DSWI and female gender (p value = 0.001) as well as a combination of BMI > 30 and level of HbA1c > 7 (p value = 0.037). Age, HbA1c > 7 with BMI <30 and BMI >30 with HbA1c < 7, failed to show any statistically significant increase in the incidence of DSWI in our study group. ConclusionsBased on our results, BIMA grafting in poorly controlled diabetic obese patients especially of female gender shouldn't be used to avoid the higher incidence of DSWI among them.