Abstract
IntroductionUse of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up.MethodsThis is a retrospective review of the medical records of 152 patients undergoing elective CABG with the use of BITA and cardiopulmonary bypass (CPB). These patients were divided into two groups, diabetics and non-diabetics. Patients with acute myocardial infarction and concomitant valvular disease were not included in the sample.ResultsPreoperative characteristics did not show significant differences between the groups, which allowed a comparative analysis. The variables electrocardiography time and aortic clamping time were higher in the diabetic group, with a significant statistical difference (P<0.0001). In-hospital mortality occurred in three patients, and there was no mortality up to 30 days in both groups. There was no significant difference in the primary end point between groups (P=0.56). Deep sternal wound infection was present in only one patient and showed no significant difference in the secondary outcome between groups (P=0.40).ConclusionWe did not observe a higher mortality and occurrence of deep sternal wound infection with the use of BITA in diabetic patients compared to non-diabetics, even with greater CPB and aortic clamping times in diabetics.
Highlights
Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time
Among the 152 patients in the sample, the age range varied from 39 to 86 years, there was a higher prevalence of males (132), and they were divided into two groups — diabetics (G1: 61 patients) and non-diabetics (G2: 91 patients); we observed that in group 1 (G1), with diabetic patients, only 12 (21.3%) were treated with oral hypoglycemic, and 49 (78.7%) were treated with insulin
The primary end point, in-hospital mortality and mortality within 30 days from discharge, was low, and the secondary end point, deep sternal wound infection with the use of BITA in diabetic patients compared to non-diabetic patients, was not statistically significant, even with greater cardiopulmonary bypass (CPB) and aortic clamping times in the diabetic group
Summary
Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up. Coronary artery bypass grafting (CABG) plays an important role in the treatment of CAD, and recent studies show that CABG has superior results compared to other treatments in the medium and long-term outcomes, mainly in the subgroup of diabetics[3]. The use of left internal thoracic artery (LITA) as a graft in CABG became gold standard after the publication of Floyd Loop, in 1986, being described for the anterior descending coronary artery, influenced by the reduction of risk of death, AMI, angina, reoperation, and a greater patency of 95% in a 10-year followup[4]. The study of a group from New York obtained a similar result, the follow-up was of up to 20 years[5]
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