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Does avoidance of cardiopulmonary bypass decrease the incidence of stroke in diabetics undergoing coronary surgery?
R Abraham1, H L Karamanoukian, M R Jajkowski
1State University of New York at Buffalo, Department of Cardiothoracic Surgery, Kaleida Health-Buffalo General Hospital, Buffalo, New York 14203, USA.
The Heart Surgery Forum
|September 7, 2001
Summary
Off-pump coronary artery bypass grafting (CABG) showed a threefold reduction in stroke incidence compared to conventional CABG in diabetic patients. This technique appears favorable for high-risk diabetics needing coronary revascularization.
Area of Science:
- Cardiovascular Surgery
- Diabetology
Background:
- Diabetes mellitus adversely affects coronary circulation, increasing cardiovascular event risk.
- Diabetic patients undergoing coronary artery bypass grafting (CABG) often have higher baseline risks, including prior myocardial infarction, heart failure, and hypertension.
- Despite improvements in surgical techniques and anesthetic management, stroke remains a significant concern in diabetic patients undergoing CABG.
Purpose of the Study:
- To compare the stroke rate between off-pump CABG (OPCAB) and conventional CABG (CPB) in patients with a history of preoperative diabetes.
- To determine if OPCAB techniques can decrease stroke incidence in this higher-risk diabetic population.
Main Methods:
- A retrospective analysis of 1,227 diabetic patients undergoing CABG between 1995 and 1999.
- Patients were divided into two groups: conventional CABG with cardiopulmonary bypass (CPB) (973 patients) and off-pump CABG (OPCAB) (254 patients).
- Preoperative risk factors, including age, sex, urgency of surgery, carotid disease, ejection fraction, congestive heart failure, hypertension, and previous myocardial infarction, were analyzed and found to be similar between groups.
Main Results:
- The stroke rate was 3.6% in the CPB group versus 1.2% in the OPCAB group.
- Although not statistically significant on its own, this represents a threefold reduction in stroke incidence with OPCAB.
- The OPCAB group had a significantly higher percentage of high-risk criteria for stroke, including re-do CABG (26.4% vs. 8.7%) and calcified aortas (7.1% vs. 2.9%), suggesting a potential benefit of OPCAB in this higher-risk cohort.
Conclusions:
- Off-pump CABG (OPCAB) demonstrated a threefold reduction in stroke incidence compared to conventional CABG (CPB) in diabetic patients.
- While not statistically significant in this retrospective study, the reduction may be clinically significant given the higher-risk profile of the OPCAB group.
- OPCAB is a favorable technique for high-risk diabetic patients requiring coronary revascularization, and further research with larger series is warranted to confirm statistical significance.