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Multiple Arterial Grafting During Coronary Artery Bypass Graft Surgery in Diabetic and Non-Diabetic Patients: A
Miralem Jasarevic1, Oskar Krueger1, Jan Strathmann1
1Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Hufelandstrasse 55, 45147 Essen, Germany.
Insights
Diabetic patients undergoing coronary artery bypass grafting with multiple arterial grafting (MAG) experienced significantly lower survival rates and more complications than non-diabetics. Diabetes is a critical factor in surgical strategy selection for these patients.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) with multiple arterial grafting (MAG) may improve survival over single arterial grafting.
- The survival benefit of MAG in diabetic patients remains uncertain.
Purpose of the Study:
- To compare short- and long-term outcomes of MAG in diabetic versus non-diabetic patients undergoing CABG.
- To evaluate the impact of diabetes on survival after MAG procedures.
Main Methods:
- Retrospective analysis of 256 diabetic and 800 non-diabetic patients who underwent CABG with MAG.
- Data collected between January 1999 and December 2019, including clinical outcomes and survival times.
Main Results:
- Diabetic patients had higher EuroScore II and less bilateral internal thoracic artery (BITA) grafting.
- Postoperative adverse events like pneumonia, stroke, and sepsis did not differ, but diabetics had more cardiogenic shock, renal failure, and sternal infections.
- Median survival was significantly lower in diabetics (14.54 years) compared to non-diabetics (19.6 years).
Conclusions:
- Diabetic patients undergoing MAG have significantly reduced overall median survival.
- Diabetes is a crucial risk factor influencing surgical strategy decisions in CABG patients.
Abstract:
Background/Objectives: Coronary artery bypass surgery (CABG) with multiple arterial grafting (MAG) has shown potential to improve patient survival compared to single arterial bypass grafting. Whether this superiority in survival also exists in diabetics is uncertain. We therefore aimed to compare short and long-term outcomes of MAG in diabetic versus non-diabetic patients. Methods: In this retrospective study, we investigated short- and long-term clinical outcomes of diabetic (n = 256) and non-diabetic (n = 800) patients undergoing CABG with MAG between January 1999 and December 2019 at our institution. Results: Diabetics had a significantly higher EuroScore II (1.37 ± 2.4 vs. 0.88 ± 1.58, p < 0.0001) and underwent significantly less bilateral internal thoracic artery (BITA) grafting (51.95% vs. 67.75%; p < 0.0001) compared to non-diabetics. The incidence of postoperative adverse events, such as pneumonia, stroke, and sepsis, did not differ between the two groups. However, diabetics suffered significantly more often from post-cardiotomy cardiogenic shock, renal failure requiring dialysis, and sternal wound infections over the entire follow-up period. Non-diabetics had a significantly higher median survival time of 19.6 years compared to 14.54 years found in diabetic patients (p < 0.0001). Conclusions: Among patients undergoing MAG, diabetic individuals were found to have a significantly lower overall median survival. This emphasizes the importance of diabetes as a risk factor in choosing individual surgical strategies.
