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Brittle diabetes --- Cardio-vasculaire [Système ] --- Cardiovasculair systeem --- Cardiovascular system --- Circulatory system --- DID (Maladie) --- Diabetes --- Diabetes Mellitus [Type 1 ] --- Diabetes mellitus --- Diabète consomptif --- Diabète de type 1 --- Diabète insulino-dépendant --- Diabète insulinodépendant --- Diabète insulinoprive --- Diabète juvénile --- Diabète maigre --- Diabète sucré de type 1 --- Diabète sucré insulinodépendant --- Diabète type 1 --- Diabète type I --- Diabètes --- Diabètes insulinodépendants --- Dysmetabolic syndrome X --- IDDM (Disease) --- Insulin-dependent diabetes --- Ketosis prone diabetes --- Metabolic syndrome --- Metabool syndroom --- Suikerziekte --- Syndrome métabolique --- Système cardio-vasculaire --- Type 1 diabetes --- Vascular system --- Academic collection --- Theses --- Metabolism

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Background Diabetes patients are more likely to develop sternal wound infection (SWI) after coronary artery bypass grafting (CABG), but it is still unclear whether an elevated hemoglobin A1c (HbA1c) plays a role in the increased risk of SWI in this patient population. Methods We conducted a retrospective cohort study at a large referral center. All patients who had undergone off-pump coronary artery bypass surgery in 2010‒2016 were eligible for inclusion. We looked at the incidence of SWI and we evaluated the association between HbA1c and SWI in diabetes patients. Results We included 1,316 non-diabetes and 458 diabetes patients. Postoperative SWI occurred in 133 (10%) of non-diabetes and 82 (18%) of diabetes patients (p < 0.001). Grade 3 SWI occurred in 2.5% of non-diabetes and 7.2% of diabetes patients (p < 0.001). The incidence of other grade SWIs was similar in both patient groups. An elevated HbA1c was associated with an increased risk of SWI (OR = 1.25, 95% CI: 1.04–1.5) and higher-grade SWI (OR = 1.25, 95% CI: 1.05–1.5) in diabetes patients. Pedicled harvesting of the internal thoracic artery (ITA) was associated with a higher risk of SWI compared to skeletonized ITA harvesting in diabetes patients (OR = 2.4, 95% CI: 1.2–4.7). Conclusion An elevated HbA1c predicted SWI after CABG in diabetes patients. Skeletonized ITA harvesting was associated with a lower risk of SWI compared to pedicled ITA harvesting in diabetes patients. Further research is warranted to see how our findings may translate to clinical practice.

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Minimal Invasive Direct Coronary Artery Bypass (MIDCAB) surgery by a left anterolateral thoracotomy (MIDCAB) might be more beneficial than Off-Pump Coronary Artery Bypass (OPCAB) due to better short-term outcomes, return to full functioning capacity, decreased rates of infection, decreased pain and improved cosmetic result. This study is a retrospective evaluation of the quality of life of patients with an off-pump coronary bypass by either anterolateral thoracotomy or median sternotomy. Patient satisfaction was examined by using a shortened CROQ-questionnaire at 4 weeks postoperatively, questioning 8 aspects: cardiac symptoms, angina medication, chest pain, general impact on life, daily limitations, social impact, personal impact and cognitive impairment. RESULTS: Response was obtained from 83 MIDCAB patients and 99 OPCAB patients. Significant difference was found for angina medication (U = 3663.00, p = 0.045) and general impact on daily life ( U = 3373.50, p = 0.027). There was no difference for the other aspects of patient satisfaction. Minimal invasive coronary bypass without cardiopulmonary bypass by a left anterolateral thoracotomy results in better patient satisfaction compared to conventional sternotomy. These results strengthen our trust in the MIDCAB-procedure and allow physicians to better counsel benefits and differences between both procedures. We stress that our population is small and our results only hypothesis-generating. A larger validation study is required to confirm these findings.

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INLEIDING: CABG en PCI spelen beiden een rol in de behandeling van coronary multivessel disease maar ze hebben beiden hun beperkingen. Hybride coronaire revascularisatie (HCR), waarbij minimaal invasieve robot geassisteerde coronaire bypass (RACAB) wordt gecombineerd met percutane coronaire interventie (PCI), zou een alternatief kunnen vormen voor CABG in de behandeling van multivessel coronary artery disease. Het doel van deze studie was analyse van de outcome van een patiëntenpopulatie die HCR onderging, alsook van de RACAB-procedure , dewelke werd gebruikt in de HCR groep. De bekomen resultaten werden vergeleken met een groep die conventionele OPCAB onderging. METHODEN: In deze retrospectieve studie analyseerden we de gegevens van 271 personen met symptomatische coronaire multivessel disease die een chirurgische behandeling kregen onder de vorm van OPCAB, RACAB of HCR. RESULTATEN: Van de 271 patiënten ondergingen er 25 (9,2%) HCR, 125 (46,1%) enkel RACAB, 81 (29,9%) OPCAB en 40 (14,8%) OPCAB LIMA/LAD op geskeletoniseerde wijze. HCR en de RACAB-procedure resulteerde in lagere postoperatieve hemoglobinedaling, minder gevallen van de novo VKF, lagere incidentie van wondproblemen en lagere incidentie van urineweginfecties in vergelijking met OPCAB. Er was geen significant verschil in hospitalisatieduur tussen HCR en OPCAB. Overall survival na HCR was na 3 jaar >96%. In de patiëntenpopulatie die HCR of RACAB onderging, werden er tijdens follow-up geen gevallen van angor gerapporteerd. CONCLUSIE: HCR vormt een veelbelovend alternatief voor conventionele CABG in de behandeling van coronary multivessel disease. Aangezien huidige evidence voornamelijk steunt op retrospectieve data, is er nood aan prospectieve studies.