The effect of diabetes on mid-term survival of open heart surgery patients aged over 70 years

Abstract

Aim: To determine the effect of diabetes on mid-term survival rates of the patients over 70 years of age who underwent an open heart surgery. Material and Method: Patients who underwent an open heart surgery between November 2016 and May 2019 in our center included in this retrospective study. The patients younger than 70 years were excluded. Patients were divided into two groups: Group 1 included diabetic patients, Group 2 included non-diabetic patients. The patients who were followed-up for less than 24 months were excluded. Results: A total 389 patients were evaluated and 93 (23.9%) patients aged over 70 years were included in this retrospective study. Group 1 included 36 (38.7%) type 2 diabetic patients and Group 2 included 57 (61.3%) non-diabetic patients. The general mean follow-up time was 48.25±10.42 months (range between 30.83-77.07 months). The number of emergency operations was significantly higher in non-diabetic patients group (p= 0.005). The mortality rates were similar in both groups (30.55% in Group1, 35.08% Group 2, p= 0.652). The survival times of the groups were also similar (63.49±3.42 months in diabetic patients, 59.40±2.67 months in non-diabetic patients group, p= 0.254). Conclusion: Diabetes mellitus has no effect on the mid-term survival rates of the older patients who underwent open heart surgery.

Keywords

• open heart surgery
• diabetes mellitus
• survival
• coronary artery bypass
• heart valve surgery

Project Number

yok

References

1. Loran D, Zwischenberger J. Thoracic surgery in the elderly. J Am Coll Surg 2004; 199: 773–84.
2. Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med 2008; 149: 11.
3. Sarıçam O, Kahveci K. Aging and geriatric palliative care. Anatolian Curr Med J 2021; 3: 251–5.
4. Cavallari I, Maddaloni E, Gragnano F, et al. Ischemic and bleeding risk by type 2 diabetes clusters in patients with acute coronary syndrome. Intern Emerg Med 2021; 16: 1583–91.
5. Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 2016; 315: 1735.
6. Lauruschkat AH, Arnrich B, Albert AA, et al. Prevalence and risks of undiagnosed diabetes mellitus in patients undergoing coronary artery bypass grafting. Circulation 2005; 112: 2397–402.
7. Nathan DM, Singer DE, Godine JE, Perlmuter LC. Non-insulin-dependent diabetes in older patients. Complications and risk factors. Am J Med 1986; 81: 837–42.
8. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999; 281: 2005–12.

9. Luft D, Deichsel G, Schmulling R-M, Stein W, Eggstein M. Definition of clinically relevant lactic acidosis in patients with internal diseases. Am J Clin Pathol 1983; 80: 484–9.
10. Nicolini F, Agostinelli A, Vezzani A, et al. the evolution of cardiovascular surgery in elderly patient: a review of current options and outcomes. Biomed Res Int 2014; 2014: 1–10.
11. Paparella D, Guida P, Di Eusanio G, et al. Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry. Eur J Cardio-Thoracic Surg 2014; 46: 840–8.
12. Wang W, Bagshaw SM, Norris CM, Zibdawi R, Zibdawi M, MacArthur R. Association between older age and outcome after cardiac surgery: a population-based cohort study. J Cardiothorac Surg 2014; 9: 177.
13. Afilalo J, Steele R, Manning WJ, et al. derivation and validation of prognosis-based age cutoffs to define elderly in cardiac surgery. Circ Cardiovasc Qual Outcomes 2016; 9: 424–31.
14. Likosky DS, Dacey LJ, Baribeau YR, et al. Long-term survival of the very elderly undergoing coronary artery bypass grafting. Ann Thorac Surg 2008; 85: 1233–7.
15. Schwann TA, El Hage Sleiman AKM, et al. Incremental value of increasing number of arterial grafts: the effect of diabetes mellitus. Ann Thorac Surg 2018; 105: 1737–44.
16. Mack MJ, Banning AP, Serruys PW, et al. Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. Ann Thorac Surg 2011; 92: 2140–6.
17. Huang ES, Laiteerapong N, Liu JY, John PM, Moffet HH, Karter AJ. rates of complications and mortality in older patients with diabetes mellitus. JAMA Intern Med 2014; 174: 251.
18. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New Engl J Med 2015; 373: 2117–28.
19. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. New Engl J Med 2017; 377: 644–57.
20. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. New Engl J Med 2019; 380: 347–57.
21. Verma S, Mazer CD, Al-Omran M, et al. Cardiovascular outcomes and safety of empagliflozin in patients with type 2 diabetes mellitus and peripheral artery disease. Circulation 2018; 137: 405–7.
22. Verma S, Mazer CD, Fitchett D, et al. Empagliflozin reduces cardiovascular events, mortality and renal events in participants with type 2 diabetes after coronary artery bypass graft surgery: subanalysis of the EMPA-REG OUTCOME® randomised trial. Diabetologia 2018; 61: 1712–23.
23. Han Y, Xie H, Liu Y, Gao P, Yang X, Shen Z. Effect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis. Cardiovasc Diabetol 2019; 18: 96.
24. Yayar Ö, Şahin M, Eser B, Savcı Ü. Metformin associated lactic acidosis resulted in cardiopulmonary arrest: a rare case. J Heal Sci Med 2018; 1: 106–9.
25. Lalau JD, Race J-M. Lactic acidosis in metformin-treated patients. Drug Saf 1999; 20: 377–84.
26. Lalau J-D. Lactic Acidosis induced by metformin. Drug Saf 2010; 33: 727–40.
27. Nazer RI, Alburikan KA. Metformin is not associated with lactic acidosis in patients with diabetes undergoing coronary artery bypass graft surgery: a case control study. BMC Pharmacol Toxicol 2017; 18: 38.
28. Varol H, Çitçi A. New treatment approaches in type 2 diabetes: an aspect to case studies. J Med Palliat Care 2020; 1: 12–5.