Surgical myocardial revascularization using the left internal thoracic artery in patients with diabetes mellitus
https://doi.org/10.21886/2219-8075-2019-10-1-13-19
Abstract
Objective: to evaluate the immediate and somewhat distant results of surgical revascularization using the left MKA in patients with diabetes, compared with the results of autovenous CABG, to identify possible complications when using the left MA in patients with diabetes. Materials and methods: 2 groups of patients who, from 2010 to 2012, were selected. performed artery bypass surgery. All patients had type II diabetes. In the first group, the mammaro-coronary artery bypass surgery (MBS) was always used, in the second group and was not performed for various reasons. Results: evaluated indicators aft er 1 year and 6 years. In the immediate postoperative period, we noted a decrease in the class of angina in both groups. We did not observe a significant difference in the violation of the healing of the sternum. In the long-term period, in the group where MBS was performed, we noted a lower mortality rate, a lower class of angina pectoris and a smaller percentage of complications in the cardiovascular system. Conclusions: In patients with multifocal lesions of the coronary bed and concomitant diabetes, the preferred method of coronary artery bypass surgery is MBS, which can be supplemented with CABG. This is confirmed by sixyear observation. MKA can be safely used in diabetes and especially in the stem lesion of the left lance. Problems with the healing of the sternum with careful allocation of LMA we have not noted.
About the Authors
Mikhail V. Gusnay
Rostov Regional Clinical Hospital;
Rostov State Medical University
Russian Federation
Russian Federation
cardiovascular surgeon doctor of the cardiac surgery department No. 2
assistant doctor for cardiovascular surgery of the department of surgical diseases FPK and PPS
Andrey V. Poddubny
Rostov Regional Clinical Hospital
Competing Interests: Head of the Cardiac Surgery Department No.2
Competing Interests: Head of the Cardiac Surgery Department No.2
Alexander A. Dyuzhikov
Rostov Regional Clinical Hospital;
Rostov State Medical University
MD, Professor Director of the Cardiac Surgery Center;
Professor Department of Surgical Diseases FPK and PPS
References
1. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, et al. Explanation of decrease in US deaths from coronary heart disease, 1980-2000. N Engl J Med. 2007;356:2388- 2398. DOI: 10.1056/NEJMsa053935
2. Dedov II, Shestakova MV, Vikulova ОK. Th e State Register of Diabetes in the Russian Federation: Status 2014 and Development Prospects. Diabetes. 2015;3:5-23. (in Russ.)
3. Dedova II, Shestakova MV. eds. Diabetes mellitus type 2: from theory to practice. Moscow: MIA, 2016. (in Russ.)
4. Sokolov EI. Diabetic heart. Moscow: Medicine; 2002. (in Russ.)
5. Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. Th e European Union of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur. Heart J. 2007;28(1):88-136. DOI: 10.1093/eurheartj/ehl260
6. Akchurin RS. 50 lectures on surgery. Surgical treatment of coronary heart disease - history and modernity. Media medica; 2007. (in Russ.)
7. Dedov II, Terékhin SA. Myocardial revascularization in patients with diabetes mellitus. Diabetes. 2010;4:18-21 (in Russ.)
8. Zhbanov IV, Minkina SM, Samoilenko MV, Shabalkin BV. Autoarterial graft s for myocardial revascularization and their morphological evaluation in patients with ischemic heart disease. Surgery. 1996;3:38-40. (in Russ.)
9. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective, observational study. BMJ. 2000;321(7258):405-12.
10. Yilmaz MB, Guray U, Guray Y, Altay H, Demirkan B, et al. Metabolic syndrome is associated with extension of coronary artery disease in patients with non-ST segment. Coron Artery Dis. 2005;16(5):287-92.
11. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.
12. Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009;373(9670):1190-7. doi: 10.1016/S0140-6736(09)60552-3.
13. Taggart DP, D’Amico R, Altman DG. Eff ect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001;358(9285):870-5. DOI: 10.1016/S0140- 6736(01)06069-X
14. Berger A, MacCarthy PA, Siebert U, Carlier S, Wijns W, et al. Long-term patency of internal mammary artery bypass graft s: relationship with preoperative severity of the native coronary artery stenosis. Circulation. 2004;110(11 Suppl 1):II36-40. DOI: 10.1161/01.CIR.0000141256.05740.69
15. Kappetein AP, Dawkins KD, Mohr FW, Morice MC, Mack MJ et al. Current percutaneous coronary intervention and coronary artery bypass graft ing practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg. 2006;29(4):486-91. DOI: 10.1016/j.ejcts.2006.01.047
16. Schmitto JD, Rajab TK, Cohn LH. Prevalence and variability of internal mammary graft use in contemporary multivessel coronary artery bypass graft . Curr Opin Cardiol. 2010;25(6):609-12. doi: 10.1097/HCO.0b013e32833f0498.
17. Calafi ore AM, Di Mauro M, Di Giammarco G, Contini M, Vitolla G et al. Eff ect ofdiabetes on early and late survival aft er isolated fi rst coronary bypass surgery in multivessel disease. J Th orac Cardiovasc Surg. 2003;125(1):144-54. DOI: 10.1067/ mtc.2003.73
18. Berry C., Tardif J., Bourassa M. Coronary heart disease in patients with diabetes: part I: recent advances in prevention and noninvasive management. J Am Coll Cardiol. 2007;49(6):631- 42. DOI: 10.1016/j.jacc.2006.09.046
19. Hirotani T, Kameda T, Kumamoto T, Shirota S, Yamano M. Eff ects of coronary artery bypass graft ing using internal mammary arteries for diabetic patients. J Am Coll Cardiol. 1999;34(2):532-8.
20. Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases shortterm mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002;40(3):418-23.
Review
For citations:
Gusnay M.V., Poddubny A.V., Dyuzhikov A.A. Surgical myocardial revascularization using the left internal thoracic artery in patients with diabetes mellitus. Medical Herald of the South of Russia. 2019;10(1):13-19. (In Russ.) https://doi.org/10.21886/2219-8075-2019-10-1-13-19
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