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糖尿病患者和非糖尿病患者冠状动脉旁路移植手术中的多动脉移植:单中心短期和长期分析

Multiple Arterial Grafting During Coronary Artery Bypass Graft Surgery in Diabetic and Non-Diabetic Patients: A Short- and Long-Term Analysis at a Single Center.

作者信息

Jasarevic Miralem, Krueger Oskar, Strathmann Jan, Jasarevic Marinela, Shehada Sharaf-Eldin, Piotrowski Jarowit Adam, Massoudy Parwis, Jakob Heinz, Kamler Markus, Akhyari Payam, Thielmann Matthias

机构信息

Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Hufelandstrasse 55, 45147 Essen, Germany.

Department of Cardiac, Thoracic and Vascular Surgery, St. Johannes Hospital Dortmund, Johannesstraße 9-17, 44137 Dortmund, Germany.

出版信息

J Clin Med. 2024 Nov 23;13(23):7082. doi: 10.3390/jcm13237082.

Abstract

: Coronary artery bypass surgery (CABG) with multiple arterial grafting (MAG) has shown potential to improve patient survival compared to single arterial bypass grafting. Whether this superiority in survival also exists in diabetics is uncertain. We therefore aimed to compare short and long-term outcomes of MAG in diabetic versus non-diabetic patients. : In this retrospective study, we investigated short- and long-term clinical outcomes of diabetic ( = 256) and non-diabetic ( = 800) patients undergoing CABG with MAG between January 1999 and December 2019 at our institution. : Diabetics had a significantly higher EuroScore II (1.37 ± 2.4 vs. 0.88 ± 1.58, < 0.0001) and underwent significantly less bilateral internal thoracic artery (BITA) grafting (51.95% vs. 67.75%; < 0.0001) compared to non-diabetics. The incidence of postoperative adverse events, such as pneumonia, stroke, and sepsis, did not differ between the two groups. However, diabetics suffered significantly more often from post-cardiotomy cardiogenic shock, renal failure requiring dialysis, and sternal wound infections over the entire follow-up period. Non-diabetics had a significantly higher median survival time of 19.6 years compared to 14.54 years found in diabetic patients ( < 0.0001). : Among patients undergoing MAG, diabetic individuals were found to have a significantly lower overall median survival. This emphasizes the importance of diabetes as a risk factor in choosing individual surgical strategies.

摘要

与单动脉搭桥术相比,多动脉移植的冠状动脉搭桥术(CABG)已显示出改善患者生存率的潜力。这种生存优势在糖尿病患者中是否也存在尚不确定。因此,我们旨在比较糖尿病患者与非糖尿病患者接受多动脉移植的短期和长期结果。

在这项回顾性研究中,我们调查了1999年1月至2019年12月在我院接受多动脉移植冠状动脉搭桥术的糖尿病患者(n = 256)和非糖尿病患者(n = 800)的短期和长期临床结果。

与非糖尿病患者相比,糖尿病患者的欧洲心脏手术风险评估系统(EuroScore)II显著更高(1.37±2.4 vs. 0.88±1.58,P < 0.0001),且接受双侧胸廓内动脉(BITA)移植的比例显著更低(51.95% vs. 67.75%;P < 0.0001)。两组术后不良事件(如肺炎、中风和败血症)的发生率无差异。然而,在整个随访期间,糖尿病患者发生心脏术后心源性休克、需要透析的肾衰竭和胸骨伤口感染的频率明显更高。非糖尿病患者的中位生存时间显著更长,为19.6年,而糖尿病患者为14.54年(P < 0.0001)。

在接受多动脉移植的患者中,发现糖尿病个体的总体中位生存期显著更低。这强调了糖尿病作为选择个体手术策略时的一个风险因素的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/270b/11642676/46db24f7dcd2/jcm-13-07082-g001.jpg

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