Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?

Amaç: Bu çalışmada koroner bypass uyguladığımız diyabetik hastaların erken dönem sonuçlarını irdeledik. Materyal ve Metod: Haziran 2001 ile Kasım 2003 tarihleri arasında kliniğimizde koroner bypass ameliyatı yapılan 536 hastanın kayıtları incelendi; 105 hastada ameliyat zamanında tip 2 diyabet mevcut idi. Diyabetik olguların %46.7’sinde tam arteriyel revaskülarizasyon gerçekleştirildi. Diyabetik olanlar ve olmayanlar hastane mortalitesi ve morbiditesi açısından kıyaslandı.Bulgular: Diyabetik grupta kadın cinsiyet, hipertansiyon, obezite ve karotis arter hastalığı sıklığı daha fazla idi. Diyabetik grupta ejeksiyon fraksiyonu daha düşüktü. Ayrıca bu gurupta sigara kullanımı ve obezite diyabetik olmayan guruba göre daha fazla idi (p < 0.05). Diyabetik gruptaki ortalama distal anastomoz sayısı (p = 0.013), eşzamanlı sol ventrikül anevrizma onarımı (p = 0.05), aortik kros klemp zamanı (p = 0.002), kardiyopulmoner bypass zamanı (p = 0.01) ve inotropik destek ihtiyacı (p = 0.024), diyabetik olmayan grupla kıyaslandığında, belirgin biçimde artmıştı. Erken mortalite açısından iki grup arasında fark bulunmadı; diyabetiklerde %2.9, diyabetik olmayanlarda %3 (p = 1.00).Sonuç: Diyabetik grupta inotrop destek ihtiyacı yüksek olduğu halde, sonuçlarımız diyabetiklerde koroner arter bypass cerrahisi erken mortalitesinin yüksek olmadığını göstermektedir.

Does type II diabetes mellitus increase mortality and morbidity in coronary artery bypass surgery?

Background: In this study, we present the early results of diabetic patients undergoing coronary surgery. Methods: A total of 536 consecutive patients who underwent coronary artery bypass grafting from June 2001 to November 2003 were reviewed; 105 of these patients had type 2 diabetes mellitus at the time of surgery. Complete arterial revascularization was achieved 46.7% of the diabetic patients. Hospital mortality and morbidity were compared as the primary outcomes.Results: Female gender, hypertension, obesity and carotid artery disease were more prevalent in the diabetic group. Diabetic patients were also had lower ejection fraction. Mean distal anastomosis number (p = 0.013), concomitant left ventricular aneurysm repair (p = 0.05), aortic cross-clamp time (p = 0.002), cardiopulmonary bypass time (p = 0.01) and need of inotropic support (p = 0.024) were significantly higher in the diabetic group than the non-diabetic group. No significant differences were found between two groups regarding the early mortality; 2.9% in diabetics and 3 % in non diabetics (p = 1.00).Conclusion: Although need of inotropic support is higher in diabetics, our results indicate that coronary artery bypass grafting in diabetic patients is not associated with higher early mortality.

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