Immediate results of standard and microsurgical techniques for coronary artery bypass grafting in patients with concomitant diabetes mellitus

Objective. To compare the immediate outcomes of microsurgical and standard techniques of coronary artery bypass grafting (CABG) in patients with diabetes mellitus (DM). Material and methods. A retrospective pseudo-randomized single-center study included 478 patients with multiple-vessel coronary artery disease (CAD) and concomitant diabetes mellitus who underwent CABG between 2012 and 2022. Patients were divided into two groups: the OPT group (n=186) — standard loupes, the MICRO group (n=292) — microsurgical technique. To reduce systematic bias and ensure group comparability, we used propensity score matching (PSM) and assigned 167 patients in each group. Intraoperative (cardiopulmonary bypass (CPB) and aortic cross-clamping time) and in-hospital outcomes (complication rate, length of hospital stay, mortality) were analyzed. Results. After PSM, both groups were comparable in clinical and demographic characteristics. Intraoperative analysis showed significantly shorter CPB (44 vs. 70 min, p<0.001) and aortic cross-clamping time (25 vs. 44 min, p<0.001) in the MICRO group. However, no significant differences were found in the incidence of postoperative complications, duration of mechanical ventilation, length of ICU-stay, hospital-stay and mortality. In the OPT group, all deaths were due to postoperative myocardial infarction, while the MICRO group was characterized by various causes of mortality. The study revealed no significant differences in rates of in-hospital major cardiovascular events and cardiac mortality. Conclusion. Microsurgical CABG in patients with DM is associated with shorter CPB and aortic cross-clamping time suggesting potential benefits of this approach. Despite no significant differences in in-hospital outcomes, a trend towards more favorable profile of fatal outcomes (with fewer myocardial infarctions) was observed in the MICRO group. Further studies are needed to investigate the impact of microsurgical techniques on long-term outcomes of CABG in patients with DM.