RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 24 VOLUME 20 NUMBER 2 • NOVEMBER 2023 Comparison of early postoperative results in patients with and without diabetes with low ejection fraction and normal serum creatinine values who underwent coronary artery bypass operation CIHAN YÜCEL, İLHAN ÖZGÖL Correspondence to: İlhan Özgöl Cihan Yücel Department of Cardiovascular Surgery, Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey e-mail: ilhanozgol@gmail.com Previously published online on 27 October 2023 in Cardiovasc J Afr S Afr J Diabetes Vasc Dis 2023; 20: 24–28 Abstract Background: Low left ventricular ejection fraction and renal insufficiency are factors that increase the risk of coronary artery bypass graft surgery in patients with diabetes mellitus. The aim of this study was to group patients with low left ventricular ejection fraction undergoing coronary artery bypass graft surgery according to the presence or absence of diabetes mellitus and to evaluate postoperative changes in serum creatinine levels and postoperative outcomes. Methods: A total of 93 patients undergoing isolated coronary artery bypass grafting were included in this singlecentre, retrospective, cohort study. Patients with a preoperative low left ventricular ejection fraction of less than 35% were included in the study. Patients were divided into diabetic and non-diabetic groups and intra- and intergroup values were compared. Pre-operative, and postoperative days 2 and 5 serum creatinine levels of the patients were measured and compared. Results: Of the 93 patients included in the study, 60 were in the diabetic group (group 1) and 33 were in the non-diabetic group (group 2). Postoperative 2- and 5-day creatinine levels were significantly higher in group 1 than in group 2 (p = 0.033 and p = 0.005, respectively). Postoperative 2- and 5-day creatinine levels were significantly higher than pre-operative creatinine levels in group 1 (p = 0.008 and p = 0.001, respectively). The intensive care unit stay was significantly longer in the diabetes mellitus group than in the group without diabetes mellitus (p = 0.031). Conclusion: Following coronary artery bypass graft surgery in patients with low left ventricular ejection fraction, which is already a risk factor, creatinine levels were found to have increased in the diabetes mellitus group. Keywords: cardiac surgery, acute kidney injury, diabetes mellitus, low left ventricular ejection fraction Coronary artery disease is one of the leading causes of death today.1 Percutaneous and medical treatment can be listed among the treatments for this disease, and surgical treatment also has an important place in ischaemic heart disease.2 Conditions such as low left ventricular ejection fraction (LLVEF < 35%), diabetes mellitus (DM) and renal failure are among the factors that increase mortality and morbidity rates in coronary artery bypass graft (CABG) surgery.1 Despite these risks, surgical treatment may be preferred to medical treatment because complete revascularisation can be achieved.3,4 Renal failure is a risk factor for CABG surgery, and CABG surgery and extracorporeal circulation are known to cause renal failure.5 Heart disease is associated with reduced renal function and progression of renal disease. The incidence of renal dysfunction after open-heart surgery is reported to be 30–50%, with 1–5% of these patients requiring permanent haemodialysis.6 DM is also a major risk factor for renal failure.7 CABG surgery in patients with LLVEF is associated with a risk of renal failure. In this study, we analysed the postoperative serum creatinine level changes in this group of patients and divided the patients with normal pre-operative creatinine values into two groups according to DM status. We also aimed to evaluate postoperative creatinine level changes and early postoperative outcomes in these groups. Methods All patients who underwent CABG surgery under cardiopulmonary bypass (CPB) in our clinic between 2019 and 2021 were retrospectively reviewed. The presence of coronary artery disease suitable for revascularisation on angiography and an LLVEF ≤ 35%, as calculated by two-dimensional echocardiogram, were the selection criteria for the study group. Patients with previous CABG, left ventricular aneurysm, coronary artery disease not suitable for CABG, moderate-tosevere mitral regurgitation, concomitant valvular heart disease, pre-operative creatinine value of 1.4 mg/ dl and above, and emergency and dialysis patients were excluded from this study. Patients with DMwere included in group 1 and those without DM (non-DM) were included in group 2. Demographic characteristics and pre- and postoperative data of the patients were compared. Local ethical approval was obtained from Prof Dr Cemil Taşçıoğlu City Hospital (number 2021/434). An informed consent form were obtained from the patients for this retrospectively designed study. Elective patients identified as CABG surgery candidates with a pre-operative creatinine level of less than 1.4 mg/dl were operated on under stable conditions. Patients were operated on at least two
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