On-pump coronary artery bypass surgery in diabetic patients: experience of an African center

Moutakiallah Younes, Aithoussa Mahdi, Seghrouchni Aniss, Atmani Noureddine, Mounir Reda, Bouzelmat Hicham, Mouine Najat, Moujahid Azeddine, Drissi Mohamed, Boulahya Abdelatif

Mohammed V Military Hospital - Faculty of Medicine and Pharmacy of Rabat - Mohammed V University, Rabat, Morocco

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–A

Abstract

Objective: Coronary artery bypass grafting (CABG) has been widely admitted in the therapeutic arsenal of coronary artery disease in diabetics with acceptable morbi-mortality. However, it requires special management which may be challenging in low-volume center in African countries. The aim of this study was to analyze outcome of CABG in diabetic population and define predictors of adverse events.

Methods: We retrospectively enrolled 400 consecutive diabetic patients who underwent On-Pump CABG at our institution between January 2000 and 2017. The mean age was 59.4±8.2 years with a sex-ratio at 4.2 and a EuroSCORE at 3.1±2.7. Tweenty six percent of patients had left main coronary artery stenosis, 53% had 3-vessels disease and 90% had proximal left anterior descending artery stenosis. The average number of bypass was 2.4±0.7. Duration of CPB and aortic cross-clamping were respectively 117.3±42.3 and 73.6±33.9 minutes.

Results: The operative mortality was 5.5% (n=22) and the late mortality was 2.3% (n=9). Follow-up was 91.3% complete, with a mean follow-up of 53.1±42.9 months (1-161). Duration of artificial ventilation, ICU stay and postoperative stay were respectively 12.8h, 65.7h and 15.6d. Postoperative complications were myocardial infarction, sternal wound infection, mediastinitis and low cardiac output syndrome in respectively 1.9%, 10.7%, 3.9% and 1.9% of patients. Multivariable Cox regression analysis revealed that female sex (OR=9.2; 95% CI=1.6-52.8; p=0.01), emergency (OR=18.5; 95% CI=2.1-162.4; p=0.009) and poor ejection fraction (OR=8.2; 95% CI=2.6-11.1; p=0.01) were predictors of major adverse cardiac events. Predictors of infective complications were prolonged artificial ventilation > 48h (OR=7.2; 95% CI=1.6-10.5; p=0.002), CPB time>2h (OR=12.1; 95% CI=3.1-21; p<0.001), smoking (OR=6.9; 95% CI=0.9-9.8; p=0.004) and body mass index > 30Kg/m² (OR=6.7; 95% CI=0.6-8.1; p=0.005).

Conclusion: Even in low-volume center in developing areas, coronary artery bypass surgery is an effective therapy for coronary artery disease in diabetic patients despite of a higher morbidity and mortality.