The Short Term Results of Complete Revascularization in Diabetic Patients by Off- Pump Coronary Artery Bypass Graft (OPCAG)

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ntroduction: Complete revascularization in diabetic patients duo to small size and diffuse involvement of vessels is a problem in cardiac surgery. Duo to known complications of on-pump CABG, the off-pump CABG has been suggested in these patients. This study was carried out to assess the short term results of complete revascularization in diabetic patients.
Materials and Methods: This retrospective study was done during 2002 to 2006 at Imam Reza Cardiac Surgery Ward on 500 patients who were operated by off-pump CABG. The patients were divided into two groups, a: diabetic (235 pts) and b: non diabetic (265 pts). The preoperative comorbidity, intraoperative measurement of the size of the artery at the site of anastomosis with different gauged probes, and the number of grafts per patient were recorded. Intraoperative and postoperative variables between two groups compared. The observed number of grafts (O) after surgery compared with the number of grafts predicted (P) before surgery. The O/P ratio or “completion index” of ≥1 signifies complete revascularization. Logistic regression analysis used to test possibility that diabetes was a predictor of poor outcomes.
Results: Diabetic patients were older, with more comorbidity (congestive heart failure, peripheral vascular diseases, dialysis-dependent). The number of grafts per patient was 4.2±1.3 (DM) and 4.2±1.3 (non-DM). The size of 875 DM and 1068 non-DM arteries were gauged. There was no statistical difference in size between DM and non-DM (in millimeters) at each artery. All ratios ranged from 0.9 to 1.2, indicating similarity between DM and non-DM. The only significant risk factor for operative death was low left ventricular ejection fraction (P=0.001).
Conclusion: patients with DM were sicker, but tolerated off-pump coronary artery bypass grafting as well as non-DM patients. The number of grafts per patient and O/P ratio signified the ability to perform complete revascularization. We were able to bypass the small target vessels, as anticipated. Diabetes is not a predictor of the outcomes.