Yıl: 2005 Cilt: 13 Sayı: 2 Sayfa Aralığı: 93 - 98 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?

Öz:
Amaç: Bu çalışmada koroner bypass uyguladığımız diyabetik hastaların erken dönem sonuçlarını irdeledik. Materyal ve Metod: Haziran 2001 ile Kasım 2003 tarihleri arasında kliniğimizde koroner bypass ameliyatı yapılan 536 hastanın kayıtları incelendi; 105 hastada ameliyat zamanında tip 2 diyabet mevcut idi. Diyabetik olguların %46.7’sinde tam arteriyel revaskülarizasyon gerçekleştirildi. Diyabetik olanlar ve olmayanlar hastane mortalitesi ve morbiditesi açısından kıyaslandı.Bulgular: Diyabetik grupta kadın cinsiyet, hipertansiyon, obezite ve karotis arter hastalığı sıklığı daha fazla idi. Diyabetik grupta ejeksiyon fraksiyonu daha düşüktü. Ayrıca bu gurupta sigara kullanımı ve obezite diyabetik olmayan guruba göre daha fazla idi (p < 0.05). Diyabetik gruptaki ortalama distal anastomoz sayısı (p = 0.013), eşzamanlı sol ventrikül anevrizma onarımı (p = 0.05), aortik kros klemp zamanı (p = 0.002), kardiyopulmoner bypass zamanı (p = 0.01) ve inotropik destek ihtiyacı (p = 0.024), diyabetik olmayan grupla kıyaslandığında, belirgin biçimde artmıştı. Erken mortalite açısından iki grup arasında fark bulunmadı; diyabetiklerde %2.9, diyabetik olmayanlarda %3 (p = 1.00).Sonuç: Diyabetik grupta inotrop destek ihtiyacı yüksek olduğu halde, sonuçlarımız diyabetiklerde koroner arter bypass cerrahisi erken mortalitesinin yüksek olmadığını göstermektedir.
Anahtar Kelime: Koroner arter köprüleme Ölüm oranı Hastalık oranı Diabetes mellitus, tip 2

Konular: Kalp ve Kalp Damar Sistemi

Does type II diabetes mellitus increase mortality and morbidity in coronary artery bypass surgery?

Öz:
Background: In this study, we present the early results of diabetic patients undergoing coronary surgery. Methods: A total of 536 consecutive patients who underwent coronary artery bypass grafting from June 2001 to November 2003 were reviewed; 105 of these patients had type 2 diabetes mellitus at the time of surgery. Complete arterial revascularization was achieved 46.7% of the diabetic patients. Hospital mortality and morbidity were compared as the primary outcomes.Results: Female gender, hypertension, obesity and carotid artery disease were more prevalent in the diabetic group. Diabetic patients were also had lower ejection fraction. Mean distal anastomosis number (p = 0.013), concomitant left ventricular aneurysm repair (p = 0.05), aortic cross-clamp time (p = 0.002), cardiopulmonary bypass time (p = 0.01) and need of inotropic support (p = 0.024) were significantly higher in the diabetic group than the non-diabetic group. No significant differences were found between two groups regarding the early mortality; 2.9% in diabetics and 3 % in non diabetics (p = 1.00).Conclusion: Although need of inotropic support is higher in diabetics, our results indicate that coronary artery bypass grafting in diabetic patients is not associated with higher early mortality.
Anahtar Kelime: Morbidity Diabetes Mellitus, Type 2 Coronary Artery Bypass Mortality

Konular: Kalp ve Kalp Damar Sistemi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1.Thourani VH, Weintraub WS, Stein B, et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg 1999;67:1045-52.
  • 2.Waller BF, Palumbo PJ, Roberts WC. Status of the coronary arteries at necropsy in diabetes mellitus with onset after age 30 years. Analysis of 229 diabetic patients with and without clinical evidence of coronary heart disease and comparison to 183 control subjects. Am J Med 1980;69:498-506.
  • 3.Clement R, Rousou JA, Engelman RM, Breyer RH. Perioperative morbidity in diabetics requiring coronary artery bypass surgery. Ann Thorac Surg 1988;46:321-3.
  • 4.Cosgrove DM, Loop FD, Lytle BW, et al. Determinants of 10 year survival after primary myocardial revascularization. Ann Thorac Surg 1986;202:480-90.
  • 5.Markwirth T, Hennen B, Scheller B, Schafers HJ, Wendler O. Complete arterial revascularization using T-graft technique in diabetics with coronary three-vessel disease. Thorac Cardiovasc Surg 2000;48:269-73.
  • 6.Stewart RD, Campos CT, Jennings B, Lollis SS, Levitsky S, Lahey SJ. Predictors of 30 day hospital readmission after coronary artery bypass. Ann Thorac Surg 2000;70:169-74.
  • 7.Herlitz J, caidahl K, Wiklund I, et al. Impact of a history of diabetes on the improvement of symptoms and quality of life during 5 years after coronary artery bypass grafting. J Diabetes Complications 2000;l:314-21.
  • 8.Yüksel M, İslamoğlu F, Atay Y, ve ark. Koroner bypass reoperasyonları sonuçlarımız ve risk faktörlerinin değerlendirilmesi. Türk Göğüs Kalp Damar Cer Derg 2000;8:668-73.
  • 9.Raza JA, Movahed A. Current concepts of cardiovascular diseases in diabetes mellitus. Int J Cardiol 2003; 89:123-34.
  • 10.Carson J, Scholz PM, Chen AY, Peterson FD, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 2002;40:418-23.
  • 11.Cohen Y, Raz I, Merin G, Mozes B. Comparison of factors associated with 30 -day mortality after coronary artery bypass grafting in patients with versus without diabetes mellitus. Am J Cardiol 1998;81:7-11.
  • 12.Assman G, Schulte H. The Prospective Cardiovascular Miinster (PROCAM) study: prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease. Am Heart J 1988;116:1713-24.
  • 13.Cooper G, Underwood M, Deverall P. Arterial and venous conduits for coronary artery bypass. A current review. Eur J Cardiothorac Surg 1996;10:129-40.
  • 14.Acar C, Jebera VA, Portoghese M,et al. revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992;54:652-60.
  • 15.Royse AG, Royse FC, Tatoulis J. Total arterial coronary revascularization and factors influencing in-hospital mortality. Eur J Cardio-horac Surg 1999; 16:499-505.
  • 16.Kaufer E, Factor SM, Frame R, Broadman RF. Pathology of the radial artery and internal thoracic arteries used as coronary artery bypass grafts. Ann Thorac Surg 1997;63:1118-22.
  • 17.Göbel H, Ihling C, Dentz J, Schaefer HE, Zeiher AM, Fraedrich G. Increased tissue endothelin-1-like immunoreactivity in the internal mammary artery of patients with diabetes or hypercholesterinemia modulates the graft flow in the per-operative period. Eur J Cardiothorac Surg 1998; 14:367-72.
  • 18.The Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 1996; 111:1200-7.
  • 19.Grossi EA, Esposito R, Harris LJ, et al. Sternal wound infections and use of internal mammary artery grafts. J Thorac Cardiovasc Surg 1991;102:342-7.
  • 20.Faglia E, Favales F, Brivio M, et al. Coronary angiography and aorto-coronary bypass surgery in type 2 diabetic patients. Diabete Metab 1995;21:420-7.
  • 21.Hirotani T, Kameda T, Kumamoto T, Shirota S, Yamono M. Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients. J Am Coll cardiol 1999;34:532-8.
  • 22.Wendler O, Hennen B, Markwirth T, Nikoloudakis N, Greater T, Schafers HJ. Complete arterial revascularization in the diabetic patient- early postoperative results. Thorac Cardiovasc Surg 2001;49:5-9.
  • 23.Iaco AL, Teodori G, Giammorco, G, et al. Radial artery for myocardial revascularization: Long-term clinical and angiographic results. Ann Thorac Surg 2001;72:464-9.
  • 24.Royse AG, Royse CF, Shah P, Williams,A, Kaushik S, Tatoulis J. Radial artery harvest technique, use and functional outcome. Eur J Cardiothorac Surg 1999; 15:186-93.
  • 25.Reddy VS, Parikh SM, Drinkwater DC, et al. Morbidity after procurement of radial arteries in diabetic patients and the elderly undergoing coronary revascularization. Ann Thorac Surg 2002;73:803-7.
  • 26.Bucerius J, Gummert LF, Walther T, et al. Impact of diabetes mellitus on cardiac surgery outcome. Thorac Cardiovasc Surg 2003;51:11 -6.
  • 27.Fietsam R Jr, Bassett J, Glover JL. Complications of coronary artery surgery in diabetic patients. Am Surg 1991;57:551-7.
  • 28.Trick WE, Scheckler WE, Tokars JI, et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2000;l 19:108-14.
  • 29.Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997;63:356-61.
  • 30.Guvener M, Pasaoglu I, Demircin M, Oc M. Perioperative hyperglycemia is a strong correlate of postoperative infection in type 2 diabetic patients after coronary artery bypass grafting. Endocrine Journal 2002;49:531-7.
  • 31.Furnary AP, Zerr KJ, GrunkeTurkcellMusteriHizmetleri.mp3meier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999;67:352-60.
APA CİHAN H, erdil n, NİSANOĞLU V, ÇOLAK C, ERDİL F, Ege E, BATTALOĞLU B (2005). Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. , 93 - 98.
Chicago CİHAN Hasan Berat,erdil nevzat,NİSANOĞLU Vedat,ÇOLAK Cengiz,ERDİL Feray,Ege Erdal,BATTALOĞLU Bektaş Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. (2005): 93 - 98.
MLA CİHAN Hasan Berat,erdil nevzat,NİSANOĞLU Vedat,ÇOLAK Cengiz,ERDİL Feray,Ege Erdal,BATTALOĞLU Bektaş Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. , 2005, ss.93 - 98.
AMA CİHAN H,erdil n,NİSANOĞLU V,ÇOLAK C,ERDİL F,Ege E,BATTALOĞLU B Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. . 2005; 93 - 98.
Vancouver CİHAN H,erdil n,NİSANOĞLU V,ÇOLAK C,ERDİL F,Ege E,BATTALOĞLU B Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. . 2005; 93 - 98.
IEEE CİHAN H,erdil n,NİSANOĞLU V,ÇOLAK C,ERDİL F,Ege E,BATTALOĞLU B "Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?." , ss.93 - 98, 2005.
ISNAD CİHAN, Hasan Berat vd. "Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?". (2005), 93-98.
APA CİHAN H, erdil n, NİSANOĞLU V, ÇOLAK C, ERDİL F, Ege E, BATTALOĞLU B (2005). Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 13(2), 93 - 98.
Chicago CİHAN Hasan Berat,erdil nevzat,NİSANOĞLU Vedat,ÇOLAK Cengiz,ERDİL Feray,Ege Erdal,BATTALOĞLU Bektaş Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. Türk Göğüs Kalp Damar Cerrahisi Dergisi 13, no.2 (2005): 93 - 98.
MLA CİHAN Hasan Berat,erdil nevzat,NİSANOĞLU Vedat,ÇOLAK Cengiz,ERDİL Feray,Ege Erdal,BATTALOĞLU Bektaş Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. Türk Göğüs Kalp Damar Cerrahisi Dergisi, vol.13, no.2, 2005, ss.93 - 98.
AMA CİHAN H,erdil n,NİSANOĞLU V,ÇOLAK C,ERDİL F,Ege E,BATTALOĞLU B Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2005; 13(2): 93 - 98.
Vancouver CİHAN H,erdil n,NİSANOĞLU V,ÇOLAK C,ERDİL F,Ege E,BATTALOĞLU B Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2005; 13(2): 93 - 98.
IEEE CİHAN H,erdil n,NİSANOĞLU V,ÇOLAK C,ERDİL F,Ege E,BATTALOĞLU B "Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?." Türk Göğüs Kalp Damar Cerrahisi Dergisi, 13, ss.93 - 98, 2005.
ISNAD CİHAN, Hasan Berat vd. "Koroner bypass cerrahisinde tip 2 diabetes mellitus mortalite ve morbiditeyi artırır mı?". Türk Göğüs Kalp Damar Cerrahisi Dergisi 13/2 (2005), 93-98.