Surgical treatment of ischemic heart disease and diabetes mellitus

Czech version

Authors: J. Harrer; A. Drašnar; J. Vojáček
Authors‘ workplace: Kardiochirurgická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta doc. MU Dr. Jan Harrer, CSc.
Published in: Vnitř Lék 2010; 56(4): 317-319
Category: 11th National Diabetes Symposium "Diabetes and Angiology", Hradec Kralove, 5 to 6 June 2009

Overview

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.

Key words:
coronary artery bypass grafting (CABG) – diabetes mellitus

Sources

1. Perušičová J. Jak ovlivňují diabetes mellitus 2. typu a zvýšená glykémie kardiovaskulární riziko? Kardiol Rev 2009; 11: 117– 121.

2. Szabó Z, Håkanson E, Svedjeholm R. Early postoperative outcome and medium‑term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2002; 74: 712– 719.

3. Filsoufi F, Rahmanian PB, Castillo JG et al. Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2007; 6: 753– 758.

4. Antunes PE, Oliveira JF, Antunes MJ. Coronary surgery in patients with diabetes mellitus: a risk‑adjusted study on early outcome. Eur J Cardiothorac Surg 2008; 34: 370– 375.

5. Thourani VH, Weintraub WS, Stein B et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg 1999; 67: 1045– 1052.

6. Carson JL, Scholz PW, Chen AY et al. Diabetes mellitus increases short‑term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. Am Coll Cardiol 2002; 40: 418– 423.

7. Marcheix B, Vanden Eynden F, Demers P et al. Influence of diabetes mellitus on long‑term survival in systematic Off‑ pump coronary artery bypass surgery. Ann Thorac Surg 2008; 86: 1181– 1188.

8. Lazar HL, Chipkin SR, Fitzgerald CA et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation 2004; 109: 1497– 1502.

9. Seven‑year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status. J Am Coll Cardiol 2000; 35: 1122– 1129.

10. Abizaid A, Costa MA, Centemero M et al. Arterial revascularization therapy study group. Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) trial. Circulation 2001; 104: 533– 538.

11. Momin AU, Deshpande R, Potts J et al. Incidence of sternal infection in diabetic patients undergoing bilateral internal thoracic artery grafting. Ann Thorac Surg 2005; 80: 1765– 1772.