Evaluation Of The Treatment Of Coronary Artery Bypass Grafting In Elderly Patients With Coronary Heart Disease Complicated With Diabetes Mellitus

Objective: Coronary artery bypass grafting (CABG) is one of the major means inthe treatment of coronary heart disease (CHD). As for the elderly patients with CHDand diabetes mellitus (DM), considering its more diffused vascular disease and thehigh incidence of multivessel disease, CABG has become the only treatment for thesepatients while the percutaneous coronary intervention (PCI) is hard to be performed inthese patients. This study aimed to investigate the treatment of CABG for elderlypatients with CHD complicated with DM.Methods: In this study, a total of158elderly patients with CHD were enrolled.All the patients were treated in the Cardiovascular Surgery department of the GeneralHospital of Shenyang Military Region from March2008to February2012,whose agewere> or=75years. According to whether suffering from DM, all the patients weredivided into two groups, the diabetic group included54cases, the non-diabetic groupincluded104cases. All the patients received coronary artery bypass grafting (CABG).According to the different surgical approaches, both the groups were divided into twosubgroups, respectively, named coronary artery bypass grafting with cardiopulmonarybypass (on-pump group) and coronary artery bypass grafting without cardiopulmonarybypass (off-pump group). Compare the total number of bypass，ICU stay, duration ofmechanical ventilation, use of intra aortic balloon pump(IABP), postoperative hospitalstay, postoperative drainage, the incidence of reoperation，mortality, as well as theincidence of neurological complications. pulmonary complications, low cardiac outputsyndrome, wound complications, renal insufficiency and atrial fibrillation.Results:1.preoperative conditions：All the patients aged from75years old to84years old, the average age was77.86 ±3.47years old, including99male cases and59female cases. The preoperative dataof diabetic group and non-diabetic group have no significant differences.2.postoperative conditions： There’s no significant difference in the total numberof bypass，ICU stay, duration of mechanical ventilation, use of IABP, postoperativehospital stay, postoperative drainage, the incidence of reoperation，mortality, as well asthe incidence of neurological complications, pulmonary complications, low cardiacoutput syndrome, wound complications, renal insufficiency and atrial fibrillation.Compared to on-pump group, off-pump group has shorter ICU stay andpostoperative hospital stay, lower incidence of neurological complications, renalinsufficiency and atrial fibrillation.Conclusion:1.There is no significant difference in the prognosis of the elderly patients withCHD complicated with DM compared to those without DM, which suggests thatdiabetes does not make a significant impact on the prognosis of elderly patients withCHD undergoing CABG.2. As for elderly patients with CHD, off-pump CABG (OPCABG) has lowerincidence of neurological complications, renal insufficiency and atrial fibrillationcompared to conventional CABG (CCABG), regardless of DM, suggesting thatOPCABG is more suitable for elderly patients with CHD.3. Compared to CCABG, OPCABG can reduce the ICU stay and postoperativehospital stay, which will then reduce the cost of hospitalization, thus，to alleviate theburden on the patients.