DIABETUS MELLITUS AND SURGICAL TREATMENT OF CORONARY HEART DISEASE

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Abstract


Nearly 40-year experience of surgical treatment of coronary heart disease testifies to higher coronary heart disease (CHD) morbidity and mortality rates among diabetes mellitus patients in comparison to non-diabetic patients. At the same time, comparative study of CHD treatment methods efficacy in diabetes mellitus patients has shown that surgery is preferred to angioplasty, especially in the most severe cases – in presence of coronary occlusion, insulin-dependent diabetes and left-ventricle dysfunction. More inferior results of coronary bypass surgery in diabetic patients in comaparison to non-diabetic were conditional on a more pronounced arterial calcinosis and diffuse distal arterial involvement, as well as more severe aortal ateromatosis, flebopathy and more often wound infection occurrence. In the department of cardio-vascular surgery in Russian cardiologic scientific productive complex a quarter of all patients waiting for the coronary bypass surgery are diabetic. Selection algorithm, preoperation preparation, peculiarities of surgical technique and principles of postoperative supervision of these patients were specially designed. With adequate preparation, remission of diabetes and use of microsurgery, postoperative prognosis for these patients (both stratified and real) is comparative to that for the main group of patients. One-year follow up after the bypass surgery data testifies to the low difference in autovenous and autoarterial shunt patency in diabetic and non-diabetic patients. Long-term (10 years) survival rate is significantly lower in the group of diabetic patients. Proposed cardioprotective postoperative strategy is designed to improve both short and long-term efficacy of surgical revascularization in CHD patients with concomitant diabetes mellitus.


R. S. Akchurin

Russian cardiologic scientific productive complex Ministry of Healthcare and Social development of Russian Federation, Moscow

Email: docElina@yandex.ru

Russian Federation доктор медицинских наук, профессор, академик РАН, заместитель директора ФГБУ Российского кардиологического научно-производственного комплекса Минздравсоцразвития России, руководитель Отдела сердечно-сосудистой хирургии

E. E. Vlasova

A.L. Myasnikov Institute of Clinical Cardiology

Author for correspondence.
Email: docElina@yandex.ru

Russian Federation кандидат медицинских наук, старший научный сотрудник Отдела сердечно-сосудистой хирургии ФГБУ Российского кардиологического научно-производственного комплекса Минздравсоцразвития России

K. V. Mershin

Russian cardiologic scientific productive complex Ministry of Healthcare and Social development of Russian Federation, Moscow

Email: docElina@yandex.ru

Russian Federation кандидат медицинских наук, врач ФГБУ Российского кардиологического научно- производственного комплекса Минздравсоцразвития России

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