Complete arterial revascularization in the diabetic patient--early postoperative results.
BACKGROUND
The prognostic benefit of arterial grafts appears to be particularly high in patients with diabetes mellitus, but has been limited by availability of grafts and sternal complications. Complete arterial coronary artery bypass grafting (caCABG) using skeletonized grafts, radial arteries (RA) and the T-graft approach may reduce the perioperative risk particularly in the diabetic patient.


METHODS
The perioperative data of 174 diabetic (group I) and 402 non-diabetic patients (group II) who underwent caCABG were studied retrospectively. The operations were performed using bilateral internal thoracic arteries (ITA) (I: 20%; II: 21%; ns) or ITA and RA (I: 80%; II: 79%; ns). Diabetic patients presented with a higher incidence of 3-vessel disease (I: 93%; II: 83%; p<0.05) and a lower left ventricular ejection fraction (I: 55+/-16%; 11:60+/-16%; p<0.05).


RESULTS
No differences were found regarding need of intraaortic balloon pump (I: 1.7%; II: 2.7%; ns), incidence of myocardial infarction (I: 1.2%; II: 1.7%; ns) and sternal complications (I: 2.3%; II: 1.0%; ns). In-hospital mortality was 1.7%(I) versus 2.2% (II) (p = ns).


CONCLUSIONS
Using skeletonized arterial grafts and the T-graft approach, caCABG in diabetic patients is as safe as in non-diabetics. With the RA as a second graft, bilateral ITA harvesting is avoidable.
Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg/Saar, Germany. chowen@med-rz.uni-sb.de
O
O
Wendler
B
B
Hennen
T
T
Markwirth
N
N
Nikoloudakis
T
T
Graeter
H J
HJ
Schäfers
D000704:Analysis of Variance; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D048909:Diabetes Complications; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017534:Radial Artery / Q000637:transplantation; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome