Coronary artery bypass grafting in patients with type 2 diabetes mellitus: a comparison between minimized and conventional extracorporeal circulation.
Diabetes mellitus (DM) is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting (CABG). The minimized extracorporeal circulation (MECC) allows a reduction of the negative effects associated with conventional extracorporeal circulation (CECC). In this study, the impact of the MECC on outcome of diabetic patients after CABG was assessed. Between January 2002 and December 2009, 1,184 patients with DM underwent elective isolated CABG using CECC (54.6%) or MECC (45.4%). All analysis was performed retrospectively. The extracorporeal circulation time was significantly reduced during MECC procedure. The postoperative increase of creatine kinase and lactate levels was significantly weaker in the MECC group (p < 0.001). Also, the transfusion requirements were significantly lower (p < 0.001). Furthermore, MECC patients had lower incidences of postoperative acute renal failure and sternal wound infections and shorter ICU and hospital lengths of stay (p < 0.05). Moreover, 30-day mortality was significantly reduced in the MECC group (p < 0.05). In conclusion, CABG surgery using MECC system is a safe alternative in patients with DM. A reduced postoperative mortality and lengths of stay, lower transfusion requirements, less renal and myocardial damage, and lower incidence of sternal wound infections encourage the usage of MECC system, especially in high-risk patients.
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Germany. assadhaneya@web.de
Assad
A
Haneya
Thomas
T
Puehler
Alois
A
Philipp
Claudius
C
Diez
Michael
M
Ried
Reinhard
R
Kobuch
Stephan W
SW
Hirt
Thomas
T
Metterlein
Christof
C
Schmid
Karla
K
Lehle
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors