Surgical revascularization in patients with diabetes mellitus

Patients with coronary artery disease (CAD) and diabetes mellitus have an increased risk of mortality when undergoing either interventional or surgical revascularization. However, the rate of necessary reinterventions is significantly lower after surgical revascularization than after percutaneous transluminal coronary angioplasty (PTCA). As yet, no results of long-term follow-up after stent implantation are available. The risk for a patient with diabetes mellitus and CAD of dying of myocardial infarction after a bypass operation is significantly lower than after PTCA. Bypass operation with sternotomy in patients with diabetes mellitus carries, however, an increased risk of post-operative mediastinitis, especially when both internal thoracic arteries are used for "totally arterial" revascularization. For this reason the internal thoracic artery should be used only unilaterally in surgical revascularization in these patients. Preoperative and postoperative stabilization of the blood sugar level is very important. Sclerosis of the vessels in close proximity to the heart (ascending aorta, carotid arteries) must be clarified preoperatively. The operation should be carried out particularly carefully, with the wound area kept as small as possible. Reexploration should definitely be avoided. If these guidelines are followed, surgical revascularization in patients with CAD and diabetes mellitus can achieve very good results.