Influence of diabetes on mortality and morbidity: Off-pump coronary arterybypass grafting versus coronary artery bypass grafting with cardiopulmonary bypass

Background. Myocardial revascularization in diabetic patients is challengin g with no established optimum treatment strategy. We reviewed our coronary artery bypass grafting experience to determine the impact of eliminating ca rdiopulmonary bypass on outcomes in diabetic patients relative to nondiabet ic patients. Methods. From January 1995 through December 1999, 9,965 patients, of whom 2 ,891 (29%) had diabetes, underwent isolated coronary artery bypass grafting . Diabetic and nondiabetic patients were further divided into groups on the basis of cardiopulmonary bypass use. Twelve percent (346 of 2,891) of diab etic patients and 12% (829 of 7,074) of nondiabetic patients underwent coro nary artery bypass grafting without cardiopulmonary bypass; the remainder h ad coronary artery bypass grafting with cardiopulmonary bypass. Nineteen pr eoperative variables were compared among treatment groups by univariate ana lysis. Results. Patients undergoing coronary artery bypass grafting without cardio pulmonary bypass compared with those having coronary artery bypass grafting with cardiopulmonary bypass had higher mean predicted mortalities (diabeti c, 3.96% versus 3.72%, p = 0.83; nondiabetic, 3.03% versus 2.86%, p = 0.79) . In nondiabetic patients, coronary artery bypass grafting without cardio-p ulmonary bypass provides an actual and risk-adjusted survival advantage ove r coronary artery bypass grafting with cardiopulmonary bypass (1.81% versus 3.44%, p = 0.0127, risk-adjusted mortality, 1.79% versus 3.61%, p = 0.007) . This survival benefit of coronary artery bypass grafting without cardiopu lmonary bypass was not seen in diabetic patients (2.89% versus 3.69%, p = 0 .452; risk-adjusted mortality, 2.19% versus 2.98%, p = 0.42). Diabetic pati ents undergoing coronary artery bypass grafting without cardiopulmonary byp ass had fewer complications, including decreased blood product use (34.39% versus 58.4%, p = 0.001), and reduced incidence of prolonged ventilation (6 .94% versus 12.10%, p = 0.005), atrial fibrillation (15.90% versus 23.26%, p = 0.002), and renal failure requiring dialysis (0.87% versus 2.75%,p 0.03 6). Conclusions. The survival advantage in nondiabetic patients treated with co ronary artery bypass grafting without cardiopulmonary bypass is not apparen t in diabetic patients. Coronary artery bypass grafting without cardiopulmo nary bypass in diabetic patients is nevertheless associated with a signific ant reduction in morbidity. (C) 2001 by The Society of Thoracic Surgeons.