Abstract
Objective. In recent years, the number of patients with diabetes mellitus (DM) after coronary
artery bypass grafting (CABG) is increasing as due to the number of patients with diabetes type
II in the world so that CABG is a preferable method of myocardial revascularization, in particular
in patients with diabetes mellitus. According to some authors, DM is not the predictor
of poor prognosis, but the number of meta-analyses show worse outcomes of CABG in patients
with DM. The aim was to study the frequency of perioperative complications in groups
of patients with diabetes type II (n=317; mean age 59 years) and in the group with carbohydrate
metabolism disorder (n=350; mean age 58 years) comparable to gender, age and comorbidity.
Results. The presence of DM in patients following CABG was not connected with perioperative
mortality increase and the number of cardiovascular complications compared to patients with
diabetes. At the same time, patients with DM after CABG have more complications after postoperative
wound. According to the results of multiple analysis, having obesity without regard to
gender, age, chronic heart failure class, the risk of long-term exudation from postoperative
wound is increasing up to 2.5 while admission of angiotensin-converting enzyme inhibitor (ACE
inhibitor) decreases the risk of this complication development more than 3 times before the procedure.
But, having DM, the risk of wound complications is more than 3,4 times regard to gender,
age, chronic heart failure class.
Conclusion. Predictors for complication development from sternal wound following CABG is
need of introduction insulin in the presence of diabetes, obesity and marked postoperative
hyperglycemia. Admission of ACE inhibitor decreases risk of wound complications before the
surgery.
References
Голухова Е. З., Чеботарева Г. Е., Магомедова Н. М., Завалихина Т. В. О некоторых аспектах выбора метода реваскуляризации миокарда у больных ишемической болезнью сердца, страдающих сахарным диабетом // Креативная кардиол. 2007. № 1-2. С. 167-177.
Дедов И. И., Терехин С. А. Реваскуляризация миокарда у больных сахарным диабетом // Сахарный диабет. 2010. № 4. С. 18-23.
Сумин А. Н., Безденежных Н. А., Безденежных А. В. и др. Влияние сахарного диабета II типа и мультифокального атеросклероза на ближайшие исходы операции коронарного шунтирования // Кардиол. и серд.-сосуд. хир. 2011. № 2. С. 13-19.
Abelev Z., Seth A., Patel R. et al. Continuous insulin infusion is associated with a reduced post-surgical length of stay, but not with the complication rate, in patients with diabetes mellitus undergoing coronary artery bypass graft // J. Endocrinol. Invest. 2011. Vol. 34, № 10. P. 770-774.
Boening A., Niemann B., Wiedemann A. et al. Coronary stenting before coronary artery bypass graft surgery in diabetic patients does not increase the perioperative risk of surgery // J. Thorac. Cardiovasc. Surg. 2011. Vol. 142, № 2. P. e53-e57
Brown J. R., Furnary A. P., Mackenzie T. A. et al. Does tight glucose control prevent myocardial injury and inflammation? Northern New England Cardiovascular Disease Study Group // J. Extracorpor. Technol. 2011. Vol. 43, № 3. P. 144-152
Desai S. P., Henry L. L., Holmes S. D. et al. Strict versus liberal target range for perioperative glucose in patients undergoing coronary artery bypass grafting: a prospective randomized controlled trial // J. Thorac. Cardiovasc. Surg. 2012. Vol. 143, № 2. P. 318-325.
ElBardissi A. W., Aranki S. F., Sheng S. et al. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database // J. Thorac. Cardiovasc. Surg. 2012. Vol. 143, № 2. P. 273-281.
Emmert M. Y., Salzberg S. P., Seifert B. et al. Is off-pump superior to conventional coronary artery bypass grafting in diabetic patients with multivessel disease? // Eur. J. Cardiothorac. Surg. 2011. Vol. 40, № 1. P. 233-239
Filsoufi F., Rahmanian P. B., Castillo J. G. et al. Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting // Interact. Cardiovasc. Thorac. Surg. 2007. Vol. 6, № 6. P. 753-758.
Haneya A., Puehler T., Philipp A. et al. Coronary artery bypass grafting in patients with type 2 diabetes mellitus: a comparison between minimized and conventional extracorporeal circulation // ASAIO J. 2011. Vol. 57, № 6. P. 501-506.
Jarvela K., Maaranen P., Harmoinen A. et al. Cystatin C in diabetics as a marker of mild renal insufficiency after CABG // Ann. Thorac. Cardiovasc. Surg. 2011. Vol. 17, № 3. P. 277-282
Keogh B. Coronary artery bypass surgery // The Society of Cardiothoracic Surgeons of Great Britain and Ireland. National adult cardiac surgical database report. 2000-2001 / Eds. B. Keogh, R. Kinsman. Oxfordshire: Dendrite Clinical Systems Ltd, 2002. P. 72-163
Kinoshita T., Asai T., Suzuki T. et al. Preoperative hemoglobin A1c predicts atrial fibrillation after offpump coronary bypass surgery // Eur. J. Cardiothorac. Surg. 2012. Vol. 41, № 1. P. 102-107.
Lazar H. L., McDonnell M. M., Chipkin S. et al. Effects of aggressive versus moderate glycemic control on clinical outcomes in diabetic coronary artery bypass graft patients // Ann. Surg. 2011. Vol. 254, № 3. P. 458-463.
Ledur P., Almeida L., Pellanda L. C., Schaan B. D. Clinical features and outcomes in patients with diabetes mellitus undergoing coronary artery bypass graft in a reference center in southern Brazil // Rev. Assoc. Med. Bras. 2011. Vol. 57, № 2. P. 200-204.
Mack M. J., Banning A. P., Serruys P. W. et al. Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome // Ann. Thorac. Surg. 2011. Vol. 92, № 6. P. 2140-2146.
Onorati F., Rubino A. S., Cuda A. et al. Impact of endothelial activation on infective and inflammatory complications after cardiac surgery in type II diabetes mellitus // Int. J. Artif. Organs. 2011. Vol. 34, № 6. P. 469-480.
Onuma Y., Wykrzykowska J. J., Garg S. et al. 5-year follow-up of coronary revascularization in diabetic patients with multivessel coronary artery disease: insights from ARTS (arterial revascularization therapy study)-II and ARTS-I trials; ARTS I and II Investigators // JACC Cardiovasc. Interv. 2011. Vol. 4, № 3. P. 317-323.
Pleskovi
Roffi M., Angiolillo D. J., Kappetein A. P. Current concepts on coronary revascularization in diabetic patients // Eur. Heart J. 2011. Vol. 32, № 22. P. 2748-2757.
Rosenfeldt F. L., Wilson M. D., Buxton B. F., Marasco S. F. Coronary artery bypass surgery provides long-term results superior to percutaneous coronary intervention // Heart Lung Circ. 2012. Vol. 21, № 1. P. 1-11.
Shaw J. E., Sicree R. A., Zimmet P. Z. Global estimates of the prevalence of diabetes for 2010 and 2030 // Diabetes Res. Clin. Pract. 2010. Vol. 87. P. 4-14.
Sz
Zhang X., Wu Z., Peng X. et al. Prognosis of diabetic patients undergoing coronary artery bypass surgery compared with nondiabetics: a systematic review and meta-analysis // J. Cardiothorac. Vasc. Anesth. 2011. Vol. 25, № 2. P. 288-298.
