Off-pump vs. on-pump bypass surgery grafting in diabetic patients with three-vessel disease: a propensity score matching study

Yu Song; Chen Wang; Chuanbin Tang; Xiaofan Huang; Dashuai Wang; Rui Li; Jingjing Luo; Yisilamujiang Tuerxun; Yuanming Li; Baoqing Liu; Long Wu; Xinling Du

doi:10.3389/fcvm.2023.1249881

Off-pump vs. on-pump bypass surgery grafting in diabetic patients with three-vessel disease: a propensity score matching study

Front Cardiovasc Med. 2023 Nov 30:10:1249881. doi: 10.3389/fcvm.2023.1249881. eCollection 2023.

Authors

Yu Song^#¹, Chen Wang^#¹, Chuanbin Tang^#¹, Xiaofan Huang¹, Dashuai Wang², Rui Li¹, Jingjing Luo¹, Yisilamujiang Tuerxun³, Yuanming Li³, Baoqing Liu¹, Long Wu¹, Xinling Du¹

Affiliations

¹ Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Xinjiang Medical University, Wulumuqi, China.

^# Contributed equally.

Abstract

Background: Controversy exists regarding the advantages and risks of off-pump vs. on-pump coronary artery bypass grafting (CABG) for patients with diabetes. We therefore compare the early clinical outcomes of off-pump vs. on-pump procedures for diabetic patients with three-vessel disease.

Materials and methods: We conducted a retrospective analysis of clinical data obtained from 548 diabetic patients with three-vessel coronary artery disease who underwent isolated CABG between January 2016 and June 2020. To adjust the differences of baseline characteristics between the off-pump CABG (OPCAB) and on-pump CABG (ONCAB) groups, propensity score matching (PSM) was used. Following 1:1 matching, we selected 187 pairs of patients for further comparison of outcomes within the first 30 days after surgery.

Results: The preoperative characteristics of the patients between the two groups were clinically comparable after PSM. The OPCAB group exhibited a significantly higher incidence of incomplete revascularization (27.3% vs. 14.4%; P = 0.002) compared with the ONCAB group. No differences were seen in mortality within 30 days between the matched groups (1.1% vs. 3.7%; P = 0.174). Notably, the OPCAB group had a lower risk of respiratory failure or infection (2.1% vs. 7.0%; P = 0.025), less postoperative stroke (1.1% vs. 4.8%; P = 0.032), and reduced postoperative ventilator assistance time (35.8 ± 33.7 vs. 50.9 ± 64.8; P = 0.005).

Conclusion: OPCAB in diabetic patients with three-vessel disease is a safe procedure with reduced early stroke and respiratory complications and similar mortality rate, myocardial infarction, and renal failure requiring dialysis to conventional on-pump revascularization.

Keywords: coronary artery bypass grafting; diabetes mellitus; off-pump; on-pump; propensity score matching.

Grants and funding

This research was funded by the National Natural Science Foundation of China (grant number 82060092), Natural Science Foundation of Xinjiang Uygur Autonomous Region of China (grant number 2020D01C181), and Natural Science Foundation of Hubei Province (grant number 2020CFB791).