Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients

Hirotani, Takashi; Kameda, Tadashi; Kumamoto, Takayuki; Shirota, Shogo; Yamano, Mototugu

doi:10.1016/s0735-1097(99)00215-6

Cited by 59 publications

(28 citation statements)

References 10 publications

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“…Therefore, arterial grafts of diabetic patients appear to maintain their biological integrity, even in the presence of poorly compensated glucose metabolism. These concepts may explain the long-lasting and excellent patency rate of the LITA graft, even in the presence of pathologies potentially affecting vessel biology (5,10).…”

Section: Discussionmentioning

confidence: 99%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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Recent studies have reported a high incidence of postoperative unfavorable cardiac-related events in patients with diabetes who underwent coronary artery bypass grafting (CABG). Structural and functional characteristics of CABG conduits, which have been shown to play an important role in patient outcome after myocardial revascularization, have not been fully investigated in diabetic subjects. Therefore, we sought to determine the influence of adult-onset diabetes on vasoreactivity and morphological profile of venous and arterial grafts. Of the 160 consecutive patients enrolled in the study, 90 were diagnosed with type 2 diabetes and 70 did not have diabetes (control group). All patients underwent evaluation of glucose control before surgery. Tissue specimens were collected from left internal thoracic artery (LITA) and saphenous vein (SV) grafts harvested during elective CABG. Functional tests were performed to assess contractile and vasodilative responses of bypass conduits. Histological evaluation was carried out to examine vessel wall structure. Univariate and multivariate analyses were performed to correlate the preoperative factors related to the control of the endocrine disorder with histological findings. Patient medical history and demographics did not differ between the groups. Diabetic patients showed significant microalbuminuria and higher plasma levels of C-peptide and GHb as compared with nondiabetic subjects. Functional tests of the LITA segments revealed no difference between groups with regard to contractile and vasodilative responses. In contrast, significant impairment in the endothelium-related vasodilation of the SV grafts was observed in diabetic subjects. Histological studies showed structural preservation of the arterial conduits in both groups. However, marked intimal abnormalities (also atherosclerotic calcified plaques) were detected in SV grafts harvested from diabetic patients. Logistic regression analysis showed that high levels of proteinuria and GHb were independent predictors of advanced structural degeneration of SV conduits. Treatment modality, duration of diabetes, and other demographic or metabolic factors were found to have no influence on the morphological characteristics of SV conduits. In conclusion, biological properties of LITA conduits for CABG were preserved in diabetic patients. However, these patients frequently showed impairment of the endothelium-dependent vasorelaxation and intimal degeneration of SV grafts. The extent of structural abnormalities of SV grafts was inversely correlated with the efficacy of the metabolic control of the endocrine disorder. Further studies are required to conclusively correlate preoperative SV graft abnormalities with postoperative conduit patency rate and the occurrence of adverse cardiac-related events in diabetic subjects.

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Section: Discussionmentioning

confidence: 99%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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“…Comparing treatment groups derived from observational data is often complicated by differing patient characteristics of the groups being compared [15,16]. The ITA/radial and ITA/vein subpopulations in both diabetes study groups were characterized by many significant demographic and risk factor differences (Table 1).…”

Section: Patient Matchingmentioning

confidence: 99%

Does radial use as a second arterial conduit for coronary artery bypass grafting improve long-term outcomes in diabetics?☆☆☆

Schwann¹,

Zacharias²,

Riordan³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Using radial as a second arterial conduit as opposed to vein grafting did not confer a survival benefit in diabetics. This unexpected result is perhaps related to relatively diminished radial graft patency and/or the augmented radial vasoreactivity characteristic of diabetics. These findings indicate that the radial survival advantage demonstrated in the general CABG population lies primarily in non-diabetics in whom this advantage may be underestimated.

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“…However, they had poorer prognosis even after adjusting for the known factors above. Recently, improvement of surgical techniques including arterial conduit and off-pump coronary bypass surgery procedures has improved the short-term outcome in DM patients [2, 3], while further investigation on long-term prognostic determinants of DM patients is warranted.…”

Section: Introductionmentioning

confidence: 99%

Impaired Exercise Capacity in Diabetic Patients after Coronary Bypass Surgery: Effects of Diastolic and Endothelial Function

Hsu

Wang

et al. 2007

Cardiology

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Objectives: The aims of this study were to clarify the influence of cardiac diastolic and peripheral vascular function on the exercise capacity of patients with coronary bypass surgery (CABG) and diabetes mellitus (DM) by tissue Doppler imaging (TDI) and flow-mediated vasodilatation (FMD), and to investigate interrelations between exercise capacity and LV diastolic function, endothelial function and biochemical parameters. Methods: We analyzed the exercise capacity, TDI at the mitral annulus and FMD in 51 uncomplicated first-time CABG survivors (23 DM) at an average interval of 21.6 ± 12.2 months after surgery. Results: Diabetics had lower E’, A’, VO₂peak, (a-v)O₂ difference, and higher E/E’ ratios (p < 0.05) than non-DM patients, but not FMD (p = 0.17). The A and E/E’ ratios correlated negatively with VO₂peak after age adjustment (r = –0.336, p = 0.024). In addition, HbA_1c, and triglyceride also correlated negatively with VO₂peak (r = –0.377, –0.307, respectively, p < 0.05). Conclusions: Diabetics after CABG had more advanced diastolic dysfunction and oxygen extraction impairment than non-DM. It suggests these factors could contribute to lower exercise capacity, risk of developing heart failure despite preserved systolic function and poorer long-term survival of diabetic patients after CABG.

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Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients

Abstract: It was suggested that IMA grafts should be preferred in diabetic patients.

Cited by 59 publications

References 10 publications

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Does radial use as a second arterial conduit for coronary artery bypass grafting improve long-term outcomes in diabetics?☆☆☆

Impaired Exercise Capacity in Diabetic Patients after Coronary Bypass Surgery: Effects of Diastolic and Endothelial Function

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