**7. Conclusions**

*The Current Perspectives on Coronary Artery Bypass Grafting*

(<0.05) was considered significant [2, 3].

median BMI was 29.1+/−4.6 kg/m2

reoperation for bleeding (**Table 3**).

mammary artery (SIMA) [4].

Statistical Package for Social and Sciences (SPSS) version was used for data management. Descriptive data analysis was performed and data were presented in number (n) and percentages (%). Mean ± SD was reported for continuous variables. Statistical signıfıcance difference was assessed by using T-test for continuous variables and Chi squared for categorical variables and proportion, *P* value of

We included 210 patients, men (n = 200) and women (n = 10). The median age was 52.1 +/−9 years, 116 patients were DM and 100 patients of them in insulin, the

Overall operative mortality was 2.8% and was recorded in three high risk

No statistical difference between the two groups was observed. There were no stroke or transient neurologic accident happened among our patients even no

Deep sternal wound infection occurred in none off our patients. Only three cases showed signs of superficial wound infection that healed promptly following

Since 1980s, internal mammary artery (IMA) has become the graft of choice, thanks to clinical and angiographic data showing its long term patency rates and its superiority over the saphenous vein graft. Subsequently, the use of more arterial grafts especially bilateral mammary arteries was studied to achieve better long-term results when compared to single IMA and SVG. Interestingly, many analyses have demonstrated that patients undergoing CABG with bilateral internal mammary artery (BIMA) grafting have significantly improved survival and freedom from repeat revascularization when compared with patients receiving a single internal

Accordingly, the use of BIMA in diabetics was studied as long as CABG has emerged as the best option of myocardial revascularization in this group [5]. However, in spite of Histological superiority of IMA and the improved outcomes, the use of BIMA in patients with diabetes mellitus is still debated mainly due to the higher risk of sternal infection which remains a life-threatening complication after

The ART trial is the first randomized study that compares outcome of single and bilateral internal thoracic artery grafting for CABG. Survival after BIMA versus SIMA grafting is being assessed by the randomized controlled Arterial Revascularization Trial (ART) [6]. Analysis of early data from this trial demonstrated similar surgical mortality and major morbidity for both the SIMA and the BIMA groups at 30 days and 1 year but with a small increase in the need for sternal wound reconstruction using BIMA. In our study BIMA used in selected diabetic patients do not lead to a significant higher incidence of deep sternal wound infection. We did not get the late survival advantage of using both internal thoracic arteries in this cohort. These results support the feasibility of CABG using BIMA

cardiac surgery associated with increased morbidity and mortality.

patients with severe LV systolic dysfunction (ejection fraction < 30%).

daily dressing, antibiotics and strict glycemic control (**Table 4**).

and the mean Euro SCORE was 4.8.

**4. Data analysis**

**5. Results**

**6. Discussion**

**124**

Excellent outcomes following BIMA grafting can be expected in diabetic patients with a similar morbimortality compared to non-diabetic patients. Thus, use of BIMA grafting is an acceptable surgical procedure technique for diabetic patients. It provides multiple grafting with the best arterial conduits (IMAs) and is associated with an acceptable risk of deep sternal infections provided that preventive measures are taken. Indeed, adherence to a policy of strict perioperative glycemic control, good surgical technique, skeletonization, as well as effective postoperative management of surgical wounds would maximize the adoption of BIMA grafting as a default revascularization strategy even for diabetic patients. Further randomized controlled trials with longer follow-up are needed to confirm the safety and efficiency of BIMA grafting in diabetics.
