Featured Articles in the October 2014 Issue of The Journal of Thoracic and Cardiovascular Surgery

Editorial Commentary in JTCVS: Arterial grafting and the challenge of the patient with diabetes

Paul A. Kurlansky

Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes mellitus

Sajjad Raza, Joseph F. Sabik III, Khalil Masabni, Ponnuthurai Ainkaran, Bruce W. Lytle, and Eugene H. Blackstone

BITA grafting with complete revascularization maximized long-term survival and is recommended for patients with diabetes undergoing surgical revascularization. It should be used in all patients with diabetes whose risk of DSWI is low and might be best avoided in obese diabetic women with diffuse atherosclerotic burden.

▶ Raza and colleagues from the Cleveland Clinic reviewed over 11,922 diabetic isolated CABG patients over a 39 year period (1972-2011) and attempted to identify patients that would derive the greatest survival benefit from an optimal surgical technique by evaluating 12 possible surgical combinations (no use of IMA, use of one IMA, use of 2 IMA grafts, incomplete revascularization, complete revascularization, off-pump, and on- pump CABG). After adjusting for patient characteristics, use of 2 IMA grafts was better than one IMA graft (21% lower late mortality), two IMA grafts was associated with more deep sternal wound infections (yet this had a small effect on survival), and complete revascularization was associated with lower late mortality (10%) compared to incomplete revascularization. Interestingly, additional risks for deep sternal wound infection included: female sex, medically treated diabetes mellitus, peripheral artery disease, prior myocardial infarction, and higher BMI; and HgA1C was not. The authors concluded that the strategy with the best predicted survival was one including use of 2 IMA grafts, complete revascularization, and off-pump techniques. The worst strategy was one including no IMA grafts, incomplete revascularization, and on-pump techniques. They noted that the survival benefit associated with the best combination was largely due to the benefit of the use of 2 IMA grafts. This article importantly reinforces the known benefit to long term survival with the use of 2 IMA grafts over one in a very large cohort of diabetic patients. [Summary and Comment by Dr. Jennifer Lawton, associate medical editor, Thoracic Surgery News].

Editorial Commentary in JTCVS: Two internal thoracic arteries really are better

Andrea Carpenter

Readers who found these articles interesting may also like to read the following papers in recent and future issues of the JTCVS sister publications, Seminars in Thoracic and Cardiovascular Surgery and Operative Techniques in Thoracic and Cardiovascular Surgery.

Seminars

▶ Discussion in Cardiothoracic Treatment and Care: Coronary Artery Bypass Grafting. John Puskas, Harold Lazar, Michael Mack, Joseph Sabik, David Taggart. Semin Thorac Cardiovasc Surg 2014 Spring; 26(1):75-94.

▶ News and Views: Editorials on Multiple Arterial Grafting. Brian Buxton and Stephen Fremes (expected publication December 2014).

▶ News and Views: Role of PCI in the Treatment of Left Main Coronary Disease. A. P. Kappetein. (expected publication December 2014).

▶ State of the Art: Post-CABG antiplatelet therapy. Victor Ferraris (expected publication December 2014).

Operative Techniques

▶ Repair of Postinfarct Ventricular Septal Defect: Anterior Apical Ventricular Septal Defect. John Conte. Oper Tech Thorac Cardiovasc Surg. 2014 Spring;19(1):96-114.

▶ Repair of Postinfarction Ventricular Septal Defect: Posterior Inferior Ventricular Septal Defect.Thomas Gleason. Oper Tech Thorac Cardiovasc Surg. 2014 Spring; 19(1):115-126

Upcoming Issues of JTCVS

The November issue of JTCVS will feature editorials, articles, and commentaries on graft patency and long-term survival with off-pump CABG, cerebral protection during congenital heart surgery, and the current status of surgery for non-small cell lung cancer. December will include editorials, articles, and commentaries on cerebral protection during aortic surgery and CABG for poor LVF.

Articles in Press

Don’t forget to visit the Journal’s Articles in Press section at https://jtcvs.com/inpress. Articles appear online shortly after acceptance in their submitted format, which is replaced with the final formatted version once the authors have approved their proofs. Once an article goes online in the Articles in Press section it is indexed in Medline, fully searchable and citable before ever appearing in print. You can also sign up for the Articles in Press email alerts or RSS feed, much as you would sign up for an electronic table of contents alert for the print issue. Go to https://jtcvs.com/user/alerts/saveaipalert.