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DOI: 10.1055/s-0032-1332244
Coronary Revascularization in diabetic patients: Off-pump versus on-pump surgery
Objectives: Coronary artery bypass grafting (CABG) is a well-established surgical procedure in diabetic patients with multiple vessel disease. However, the surgical burden with extracorporeal circulation and cardioplegia-induced cardiac arrest is high in these patients. The present study investigated if in diabetic patients off-pump CABG decreases 30-day mortality and mid-term mortality in comparison to conventional CABG.
Methods: From February 2009 to October 2011, 355 consecutive adult diabetic patients undergoing off-pump CABG and 502 patients undergoing on-pump CABG were prospectively recorded. Data analysis was performed by propensity Score (PS)-adjusted logistic regression analysis and PS-adjusted Cox regression analysis. Primary endpoint was 30-day mortality. Secondary endpoints were major complications and follow-up mortality.
Results: Off-pump CABG was associated with a significantly lower 30-day mortality rate (0.3% vs. 4.2%; adjusted odds ratio = 11.0 [95% CI: 1.43; 84.7] P = 0.021) compared to on-pump CABG. Results coincided with a lower rate of postoperative neurological complications in patients undergoing off-pump CABG (1.7% vs. 5.4%; adjusted odds ratio = 3.26 [95% CI: 1.30; 8.16] P = 0.012) and a less frequent need of hemofiltration in these patients (3.4% vs. 10.4%.; adjusted odds ratio = 3.36 [95% CI: 1.57; 7.19] P = 0.002). The off-pump technique decreased the 6-month mortality rate (2.3% vs. 8.8%; adjusted hazard ratio = 3.70 [95% CI: 1.64; 8.32] P = 0.002) and also the 1-year mortality rate (4.0% vs. 10.6%; adjusted hazard ratio = 2.48 [95% CI: 1.34; 4.61] P = 0.004) significantly.
Conclusions: Our data indicate that in diabetic patients off-pump CABG is superior compared to the on-pump technique regarding postoperative complications and early and mid-term survival.