[Surgical treatment of ischemic heart disease and diabetes mellitus].
At present, treatment of IHD is relatively frequently surgical. Approximately every fourth patient undergoing surgery for IHD is a diabetic. The surgery itself does not differ from non-diabetic patients except for the specific preparation of a diabetic patient with respect to glycaemia control and with respect to metabolic demands associated with the surgical intervention. Frequent involvement of more extensive as well as more peripheral regions of the coronary arteries makes the surgical intervention more difficult. The differences with respect to mortality have been diminished mainly due to the continuously improving cardiac surgery and expanding knowledge of pathophysiology of DM, enabling better control and correction of glycaemia. However, the differences with respect to morbidity still remain (higher incidence of wound healing problems, higher incidence of strokes, renal failure, longer mean duration of hospitalization). Furthermore, long-term survival in diabetic patients is shorter, particularly due to more rapidly progressing atherosclerosis. The outcomes of IHD treatment in diabetic patients might improve when these well-known issues are fully acknowledged. The best possible diabetes treatment might contribute to this. Surgical treatment of IHD, particularly arterial grafting and use of as gentle as possible approaches (myocardial revascularization from mini-invasive entry pathways, possibly without extracorporeal circulation) also encompass great potential for outcome improvement.
Harrer
J
J
Kardiochirurgická klinika Lékarské fakulty UK a FN Hradec Králové. jharrer@seznam.cz
Drasnar
A
A
Vojácek
J
J
D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care