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Total arterial off-pump coronary artery bypass grafting was not associated with inferior outcomes for diabetic when compared with non-diabetic patients.

Abstract：

OBJECTIVES:Diabetes mellitus is a strong risk factor that worsens the clinical outcome of patients undergoing coronary artery bypass grafting (CABG). With the development of the off-pump CABG technique, there is a current trend in revascularization strategies towards in situ all-arterial grafting. We were interested in whether total arterial off-pump CABG could improve the outcome for diabetic patients. METHODS:From January 2002 to December 2013, a total of 1064 patients underwent off-pump CABG at our institution, with total arterial reconstruction carried out in 775 cases. Of the 775 patients, 436 had diabetes (DM) and 339 did not (nDM). After propensity score matching, 301 cases from each group were successfully matched. RESULTS:All procedures were performed via the off-pump technique without conversion to on-pump. Four patients in the DM group and 1 in the nDM group died in hospital. Multivariate analysis revealed that chronic pulmonary disease [odds ratio (OR) 7.04, P = 0.036] and low (<40%) ejection fraction (OR 11.3, P = 0.009) are independent risk factors for hospital death, and advanced age for deep sternal infection (OR 1.07, P = 0.04). Follow-up was completed in 97.7% of the patients to a maximum of 11.9 years. The rate of 10-year freedom from all-cause mortality was 84.2% in the DM and 74.3% in the nDM group (P = 0.45). The corresponding rates for major adverse cardiac event were 93.3 and 86.9% (P = 0.09). Multivariate Cox regression analysis revealed chronic renal failure, older age, cerebrovascular accident, low ejection fraction and urgency as significant predictors of late death. Diabetes was not associated with any long- or short-term outcome. CONCLUSIONS:Total arterial off-pump CABG using skeletonization technique can provide similar clinical outcome for diabetic patients in the long as well as in the short term as that for non-diabetic patients.

journal_name

Interact Cardiovasc Thorac Surg

journal_title

Interactive cardiovascular and thoracic surgery

authors

Suzuki T,Asai T,Kinoshita T

doi

10.1093/icvts/ivv234

subject

Has Abstract

pub_date

2015-12-01 00:00:00

pages

705-11

issue

eissn

1569-9293

issn

1569-9285

pii

ivv234

journal_volume

pub_type

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Total arterial off-pump coronary artery bypass grafting was not associated with inferior outcomes for diabetic when compared with non-diabetic patients.