Thorac Cardiovasc Surg 2016; 64 - OP151
DOI: 10.1055/s-0036-1571596

Coronary Revascularization in Diabetic Patients: 3-year Survival Data for Off-pump and on-pump Technique

S. Helms 1, A. Zittermann 1, A. Aboud 1, K. Hakim-Meibodi 1, J. Börgermann 1, A. Renner 1, J. Gummert 1
  • 1Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany

Objective: Coronary artery bypass grafting (CABG) is a well-established procedure in diabetic patients with multiple vessel disease. However, the surgical burden with extracorporeal circulation and cardioplegia-induced cardiac arrest is high in these patients. Off-pump CABG seems to be a promising surgical option for diabetic patients, as our previous studies have already shown beneficial effects of this technique on postoperative complications and early survival. Here, we present follow-up data on 3-year overall survival in diabetic patients undergoing off-pump CABG and on-pump CABG, respectively.

Methods: From February 2009 to October 2011, 355 consecutive diabetic patients undergoing off-pump CABG and 502 patients undergoing on-pump CABG were prospectively recorded. Mortality and survival data for up to 3 years were analyzed using propensity score (PS)-adjusted Cox regression analysis.

Results: Previously, we have already shown that compared with on-pump CABG, off-pump CABG was associated with significantly lower 30-day mortality (0.3% versus 4.2%; PS-adjusted odds ratio = 11.0 [95% CI: 1.43 to 84.7] p = 0.021), 6-month mortality (2.3% versus 8.8%; PS-adjusted hazard ratio = 3.7 [95% CI: 1.64 to 8.32] p = 0.002) and 1-year mortality (4.0% versus 10.6%; PS-adjusted hazard ratio = 2.48 [95% CI: 1.34 to 4.61] p = 0.004) in diabetic patients. The most recent results on 3-year overall survival in this cohort still indicate a trend for better survival in the off-pump group than in the on-pump group (88.7% versus 82.8%, PS-adjusted relative risk 0.74 [95% CI: 0.50 - 1.09] p = 0.127). Completeness of 3-year follow-up data was 99.4%.

Conclusion: The advantage of the off-pump technique for our diabetic patient collective on perioperative mortality seems to continue for at least up to 3 years. Hence, our data indicate that the off-pump technique is a safe and feasible surgical procedure for the coronary revascularization in diabetic patients.