Off-pump Coronary Artery Bypass Surgery with Multiple Arterial Grafts in Diabetic Patients: Short and Long-term Results

Abstract

IntroductionDiabetes mellitus has been identified as a strong independent predictor of cardiovasculardisease onset and progression and acknowledged as a mortality risk factorafter coronary artery surgery. Off-pump coronary artery bypass grafting has been establishedas an efficient alternative to coronary revascularization, comparable to theconventional technique, with results evidencing a reduction in procedure morbidityand, in high risk patients, lower postoperative mortality.ObjectiveThe aims of this study were to compare short and long-term postoperative results ofoff-pump coronary artery revascularization surgery with multiple arterial grafts inpatients with or without diabetes mellitus and to determine if postoperative hyperglycemiais an independent predictor of early morbidity and mortality.MethodsOff-pump coronary revascularization surgery with multiple arterial grafts was consecutivelyperformed on 1002 patients between January 2004 and December 2008.The population was divided in diabetes mellitus (n: 234) and non-diabetes mellitus(n: 768) patients. Post-operative complications were analyzed and independent predictorsof in-hospital mortality were identified. The average follow-up period of 1038± 517 days was completed by 95.7% of patients.ResultsDiabetes mellitus patients had lower cardiac output (p=0.005), atrial fibrillation(p=0.005) and deep sternal wound infection (p=0.005). Age (OR= 1.11), non-electivesurgery (OR=5.88) and blood glucose level > 200 mg/dL (OR= 6.9) were significantpredictors of in-hospital mortality. Five-year survival was lower in diabetesmellitus patients (p=0.01). Diabetes mellitus (HR = 2.1), age (HR= 1.06), left ventricularejection fraction 1.6 mg/dL(HR=2.46) were significant predictors of decreased long-term survival.ConclusionsDiabetes mellitus and non-diabetes mellitus patients had similar in-hospital mortalityrates. Postoperative hyperglycemia was a predictor of greater in-hospital mortality.Diabetes mellitus and creatinine > 1.6 mg/dL were independent predictors ofdecreased long-term survival.