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Benefit of Off Pump Coronary Artery Revascularization technique in Diabetic Patients
Pradeep Narayan, Debasis Das, Rahul Guha Biswas, saibal Roy Chowdhury, Emmanuel Rupert, Mrinalendu Das.
RTIICS, Kolkata, India.

OBJECTIVE: Diabetes mellitus is recognized as a risk factor for mortality and morbidity after coronary artery bypass grafting (CABG). There is some evidence of Off Pump Surgery (OPCAB) being beneficial in diabetics. Aim of this study was to examine if the strategy of revascularization had an impact on outcomes.
METHODS: This was a single centre, retrospective study in which over a four year period, 2202 consecutive patients undergoing isolated, primary, coronary artery bypass grafting were included. Diabetes was defined as those having HbA1c Level > 6.5 and were on medications for diabetes. Based on the strategy of revascularization the patients were placed in Group A (OPCAB) or Group B (Conventional CABG). The groups were compared for baseline; operative characteristics and Post- operative outcomes.
RESULTS: Incidence of adverse neurological; renal complications were significantly lower in diabetics undergoing OPCAB. Need for higher inotropic support, Intra-aortic Balloon pump; incidence of atrial fibrillation and respiratory complications were all significantly higher in patients undergoing revascularization using cardiopulmonary bypass. (Table 1). Early mortality in diabetics was significantly better with OPCAB as the strategy of revascularization. (1.89% vs. 4.79%; Odd’s Ratio 2.61; 95% CI 1.52- 4.02)
CONCLUSIONS: OPCAB as a strategy of revascularization in diabetics undergoing coronary artery bypass leads to significantly better outcomes.
Post-operative Outcomes
Group B
OPCAB [n=1639]
Group A
ON PUMP [n=563]
p Value
HIGH IONOTROPIC SUPPORT14(0.9%)38(6.7%)<0.001
ATRIAL FIBRILLATION197 (12%)117(20.8%)<0.001
NEED FOR IABP63(3.8%)46(8.17%)<0.001
RESPIRATORY COMPLICATIONS302(18.4%)166(29.5%)<0.001
POST OP RENAL IMPAIRMENT37(2.3%)39(6.92%)<0.001
CNS COMPLICATIONS40(2.4%)32(5.7%)<0.001

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