Does diabetes affect the postoperative outcomes after total arterial off-pump coronary bypass surgery in multivessel disease?
BACKGROUND
Previous studies have reported conflicting results regarding the adverse effects of diabetes on surgical outcomes after coronary artery bypass grafting (CABG). We reviewed our experience to determine the impact of diabetes on early and midterm surgical outcomes of patients with multivessel disease who underwent total arterial revascularization with avoidance of cardiopulmonary bypass.


METHODS
Between January 1998 and December 2003, 517 patients with multivessel disease underwent total arterial off-pump CABG; 214 were diabetic (DM group) and 303 were nondiabetic (NDM group). The DM group was sicker than the NDM group (more left ventricular dysfunction, postinfarction angina, previous myocardial infarction, and chronic renal failure). Mean follow-up period was 34 +/- 17 months. The multivariate risk factors for operative mortality, one-year angiographic patency, and midterm survival were analyzed.


RESULTS
Mean numbers of distal anastomoses were not different between the two groups (DM, 3.1 +/- 0.9; NDM, 3.0 +/- 0.8). Operative mortality was 1.4% (DM, 1.4% vs NDM, 1.3%; p = not significant [ns]). No differences were found in the incidences of postoperative morbidities, including mediastinitis and superficial wound problems, between the two groups. In immediate postoperative angiography, the patency rates were 99.2% in the DM and 98.9% in the NDM group (p = ns). One-year patency rates in angiography were also similar between the two groups (DM, 96.0%; NDM, 95.4%; p = ns). Multivariate analysis indicated that diabetes was not an independent risk factor of steno-occlusion at one-year follow-up angiography. Five-year cumulative survival was 87.7 +/- 4.1% in the DM, and 94.2 +/- 1.4% in NDM (p = ns) group. Five-year freedom from cardiac death was 99.0 +/- 0.7% in the DM, and 97.4 +/- 1.0% in the NDM (p = ns) group. Old age (age > 75 years) and chronic renal failure were independent risk factors for lower midterm survival. Our study failed to demonstrate that diabetes was an independent risk factor for lower midterm survival.


CONCLUSIONS
Diabetes mellitus did not affect the early postoperative and midterm results, including one-year graft patency, in patients with multivessel disease undergoing total arterial and off-pump CABG.
Choi
Jae-Sung
JS
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Cho
Kwang Ree
KR
Kim
Ki-Bong
KB
D000368:Aged; D000792:Angiography; D016022:Case-Control Studies; D015984:Causality; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000453:epidemiology; D048909:Diabetes Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007723:Korea / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D012016:Reference Values; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D014652:Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014654:Vascular Patency
D007328:Insulin