Off-Pump Coronary Artery Bypass Grafting for Poorly Controlled Diabetic Patients

Objective: To estimate the postoperative outcome of off-pump coronary artery bypass grafting (OPCAB) for patients with poorly controlled diabetes mellitus as evaluated by pre-operative hemoglobin A1c (HbA1c). Patients and Methods: The preoperative value of HbA1c in 101 diabetic patients who had undergone OPCAB from January 2000 to January 2007 was reviewed. A value of 6.5% was used as an indicator of poorly controlled hyperglycemia, and patients were distributed into a well-controlled group (group A: HbA1c <6.5, n = 47) or a poorly controlled group (group B: HbA1c >6.5, n = 54). The average follow-up period was 2.2 +/- 1.3 years. Results: There was no difference in the number of anastomoses (group A: 2.76 +/- 1.00 vs. group B: 2.63 +/- 0.80; p = 0.45) or the use of bilateral internal thoracic arteries (78.7% vs. 81.4%; p = 0.80). Postoperative angiography was carried out in 97 patients. The graft patency rate was 96.9% (126/130) in group A and 99.2% (131/132) in group B (p = 0.37). The stenosis free rate was 92.3% (120/130) in group A and 93.1% (123/132) in group B (p = 0.82). There were no operative deaths, no hospital deaths, and no late cardiac deaths. Postoperative atrial fibrillation occurred in 14 patients (29.7%) of group A and 12 (22.2%) of group B (p = 0.49). Wound dehiscence occurred in 2 patients (4.3%) of group A and 5 (9.3%) of group B (p = 0.44). Postoperative hospital stay lasted 22.1 +/- 9.5 days in group A and 21.7 +/- 9.1 days in group B (p = 0.86). Conclusions: OPCAB is feasible in patients having poorly controlled diabetes mellitus, and their condition does not compromise the surgical outcome. (Ann Thorac Cardiovasc Surg 2009; 15: 18-22)