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Related Experiment Videos

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
PubMed
Summary

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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.

Related Experiment Videos

  • 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.