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Improved graft patency rates and mid-term outcome of diabetic patients undergoing total arterial myocardial
Claudio Muneretto1, Gianluigi Bisleri, Alberto Negri
1Division of Cardiac Surgery, University of Brescia Medical School, Brescia - Italy.
Insights
Total arterial grafting in diabetic patients undergoing coronary artery bypass graft surgery (CABG) significantly improves graft patency and reduces cardiac events compared to conventional CABG. This approach enhances long-term outcomes for diabetic patients needing heart revascularization.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Vascular Biology
Background:
- Diabetes mellitus is a significant risk factor associated with poorer outcomes after coronary revascularization procedures.
- Limited data exist regarding the efficacy of total arterial grafting versus conventional saphenous vein grafting in diabetic patients undergoing coronary artery bypass graft surgery (CABG).
- Understanding the impact of different grafting strategies is crucial for optimizing surgical outcomes in this high-risk population.
Purpose of the Study:
- To compare the outcomes of total arterial grafting versus conventional CABG in diabetic patients.
- To evaluate graft patency rates and clinical outcomes at mid-term follow-up.
- To assess the incidence of cardiac-related events and the need for reintervention.
Main Methods:
- A retrospective study comparing 100 diabetic patients who underwent CABG with total arterial grafting (Group 1) to 100 matched diabetic patients who received conventional CABG with saphenous veins (Group 2) between 1999 and 2003.
- Patients were matched for Euroscore and other key risk factors including age, obesity, hypertension, left ventricular ejection fraction (LVEF), previous myocardial infarction, and chronic obstructive pulmonary disease (COPD).
- Outcomes assessed included early postoperative complications, hospital mortality, graft patency rates via angiography at 34 months, and mid-term cardiac events.
Main Results:
- Early postoperative outcomes and hospital mortality were comparable between the total arterial grafting group and the conventional CABG group.
- At a mean follow-up of 34 months, total arterial grafting demonstrated a significantly higher graft patency rate (96% vs. 83.6%, p=0.02).
- Patients receiving total arterial grafts experienced a significantly lower incidence of recurrent myocardial ischemia (7 vs. 18 pts., p=0.03), late myocardial infarction (2 vs. 10 pts., p=0.03), and need for coronary reintervention (1 vs. 12 pts., p=0.004).
Conclusions:
- Total arterial grafting in diabetic patients undergoing CABG significantly enhances the benefits of coronary surgery.
- This strategy provides superior mid-term graft patency and a reduced incidence of cardiac-related adverse events.
- Total arterial grafting is recommended for diabetic patients requiring coronary revascularization to improve long-term outcomes.
Objectives:
Diabetes negatively affects the outcome of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) or coronary surgery. However, data are lacking with respect to the impact of arterial revascularization in the diabetic population.
Methods:
Between 1999 and 2003, 100 of 491 diabetics underwent coronary artery bypass graft surgery (CABG) with total arterial grafting (Group 1, G1); these patients were compared with 100 diabetics undergoing conventional CABG with saphenous veins (Group 2, G2), who were matched for Euroscore and other risk factors such as age, obesity, hypertension, left ventricular ejection fraction (LVEF), previous myocardial infarction and chronic obstructive pulmonary disease (COPD).
Results:
Both groups had a similar number of diseased coronary vessels (G1=2.6 vs G2= 2.7) and received a similar degree of myocardial revascularization (grafted vessels: G1=2.2 vs G2=2.4). Early outcome was comparable between the groups in terms of ventilatory support (G1=10.8±6 vs G2=10.4±5 hours), intensive care unit (ICU) stay (G1=24±12 vs G2=25±14 hours) and major post-operative complications such as atrial fibrillation (G1=26% vs G2=28%), peri-operative myocardial infarction (G1=1% vs G2=2%)and prolonged ventilatory support (G1=6% vs G2=5%). Hospital mortality was 2% in G1 and 3% in G2. Angiography was performed at a mean follow-up of 34 months in 65.9% and 71.1% of hospital survivors of G1 and G2 respectively: patients of G1 showed a significantly higher patency rate (G1=96% vs G2=83.6%, p=0.02). Additionally, patients of G1 showed a significantly lower incidence of recurrent myocardial ischemia (G1=7 pts. vs G2=18 pts., p=0.03), late myocardial infarction (G1=2 pts. vs G2=10 pts., p=0.03) and need for coronary reintervention (G1=1 pt. vs G2=12 pts, p=0.004).
Conclusions:
Total arterial grafting in diabetic patients significantly improved the benefits of coronary surgery providing at mid term a higher graft patency rate with a lower incidence of cardiac related events.
