Myocardial revascularization in patients with type 2 diabetes mellitus: An overview of modern techniques

For patients with coronary artery disease (CAD), in combination with diabetes mellitus, diffuse multivessel coronary artery lesions are common. Such patients are prone to a more rapid progression of atherosclerosis, significantly increasing the need for myocardial revascularization. The choice of an optimal approach determines the prognosis and course of CAD. The results of randomized trials show that the use of percutaneous coronary interventions with drug-eluting stents is appropriate for patients with one or two coronary artery lesions, but that coronary artery bypass graft surgery is preferred in cases of multivessel disease and significantly reduces the risk of long-term adverse events. It should also be noted that the use of modern generations of stents allows the achievement of comparable results in terms of long-term mortality, which was most convincingly demonstrated in patients with one or two vascular lesions.

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Association of type 2 diabetes mellitus and mortality after coronary artery bypass graft surgery- a meta analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.308 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

A Abdul Razzack ◽

S Pothuru ◽

S Adeel Hassan ◽

S Mandava ◽

K Theja Reddy ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM. Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcome was all-cause mortality. Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p < 0.00001, I2 = 36)as opposed to patients without T2DM. Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery. Abstract Figure.

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Diabetes mellitus and its impact on long-term outcomes after coronary artery bypass graft surgery

Acta Diabetologica ◽

10.1007/s00592-010-0223-3 ◽

2010 ◽

Vol 50 (2) ◽

pp. 123-128 ◽

Cited By ~ 15

Author(s):

M. A. M. Wit ◽

M. de Mulder ◽

E. K. Jansen ◽

V. A. W. M. Umans

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Long Term Outcomes

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Assessment of the Radial Artery and Hand Circulation by Computed Tomography Angiography: A Pilot Study

The Heart Surgery Forum ◽

10.1532/hsf98.20041042 ◽

2005 ◽

Vol 8 (1) ◽

pp. 28 ◽

Cited By ~ 13

Author(s):

Omer Faruk Dogan ◽

Musturay Karcaaltincaba ◽

Umit Duman ◽

Deniz Akata ◽

Aytekin Besim ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Radial Artery ◽

Anatomic Variation ◽

Artery Bypass ◽

Bypass Graft ◽

Preoperative Imaging ◽

Median Artery ◽

Test Result

Objectives: The radial artery (RA) is increasingly being used as a coronary bypass graft. Results of a previous study using Doppler ultrasound and histopathologic examinations indicated that the RA has a higher incidence of preexisting intimal hyperplasia, medial calcification, and atherosclerosis than the internal thoracic artery. The aims of this study were to evaluate the use of computed tomographic angiography (CTA) to display hand collateral circulation, to define the criteria for an abnormal CTA test result, and to demonstrate usefulness of CTA as an alternative to conventional angiography for evaluation of the radial artery. Materials and Methods: Sixteen patients scheduled for coronary artery bypass grafting entered this study. We performed 32 examinations of forearm and hand arterial anatomy in these patients. CTA was performed in patients with a normal Allen test result, except 1 patient who had a persistent median artery. Soft tissue density forehand roentgenography was performed in all patients before the CTA evaluation. There was no selection of patients in relation to patient characteristics. As a risk factor for radial artery calcification, 6 of the patients had diabetes mellitus, 6 had aortofemoral occlusive disease, and 4 had a history of smoking. Results: Bilateral forearm arteries were visualized in all patients. Severe RA calcification was found in 1 patient, and distal occlusion was found in another patient. Focal RA calcification was noted in 2 patients. In the remaining patients no radial artery calcification or occlusion was noted. Anatomic variation of the upper limb arteries was shown in 2 patients; these variations were persistent median artery with absence of the radial and ulnar arteries and high bifurcation of the radial artery from the brachial artery. Conclusion: CTA is useful and safe for detection of radial artery calcific disease and assessment of the forehand circulation and its anatomic variations. Preoperative imaging of the RA is a means to avoid unnecessary forearm exploration or inadvertent use of a diseased conduit in coronary artery bypass candidates with multiple risk factors such as diabetes mellitus.

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Faculty Opinions recommendation of Long-term prognosis in patients with type 1 and 2 diabetes mellitus after coronary artery bypass grafting.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725450138.793533020 ◽

2017 ◽

Author(s):

Zeljko Bosnjak

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Long Term Prognosis

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Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1584688 ◽

2016 ◽

Vol 65 (04) ◽

pp. 265-271

Author(s):

Andrea Perrotti ◽

Enrica Dorigo ◽

Camille Durst ◽

Djamel Kaili ◽

Sidney Chocron ◽

...

Keyword(s):

Coronary Artery ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Univariate Analysis ◽

Bypass Graft ◽

Myocardial Revascularization ◽

Wound Complication ◽

Safe Procedure ◽

Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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Factors associated with return to work after coronary artery bypass grafting (CABG)

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.360 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

A Raynaldo

Keyword(s):

Diabetes Mellitus ◽

Logistic Regression ◽

Coronary Artery ◽

Return To Work ◽

Coronary Artery Bypass ◽

Functional Capacity ◽

Artery Bypass ◽

Bypass Graft ◽

Factors Associated ◽

Cabg Patients

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative CABG patients will generally experience improvement in symptoms and functional capacity. Post-CABG patients are expected to be productive again in order to have a positive impact on both patient and the society socio-economically, in addition to other parameters such as morbidity, mortality and serious adverse events. Purpose to determine the factors that associated with return to work in CABG patients in one General Hospital. Methods. We analyzed data from Adam Malik Hospital registry of 68 patients who had undergone CR after coronary artery bypass graft (CABG) in 2017-2020. The outcomes assessed were work status in 6 month after CABG. Patients’ characteristics, sociodemographic, clinical parameters of functional capacity using 6 minutes of walk test (6MWT), T2DM, Hypertension and cholesterol level were assessed. Factors associated with return to work were identified using multivariable logistic regression. Results We identified 68 patients undergoing isolated CABG (2017–2020). One year after discharge for CABG, 40 (58.8%) patients had returned to the workforce. Factors associated with return to work were identified using bivariate logistic regression. Diabetes mellitus (odds ratio, 10.192; 95% confidence interval, 0.063–0.515). Conclusion Almost 2 from 3 patients after CABG returned to work within 6 months. Diabetes mellitus and functional capacity were associated with a lower likelihood of returning to work.

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