Bypass Surgery and Wound Healing in Diabetic (Sugar) Patients

Diabetes is one of the leading comorbidities affecting the decision for coronary bypass in our clinic; it directly influences both the extent of the vascular disease and wound healing after surgery. In this article I will explain the effect of diabetes on the bypass decision and on the treatment process.

The Effects of Diabetes on the Vascular Structure

Long-standing high blood sugar leads to a disease process in the vessel wall that is widespread and also involves smaller-calibre vessels; for this reason coronary artery disease in diabetic patients is usually more diffuse and more complex. This diffuse involvement frequently results in multivessel disease that cannot be solved with a single stent.

Why Is Bypass Preferred in Diabetic Patients?

In patients with diabetes and involvement of more than one vessel, a large randomised trial (FREEDOM) showed that bypass significantly reduced rates of death and heart attack compared with stenting, while the risk of stroke increased somewhat. These data form the basis of our recommendation of bypass as the first choice in diabetic patients with multivessel coronary disease.

Blood Sugar Control and Infection Prevention After Surgery

In diabetic patients, the issue we are most careful about after surgery is the risk of breastbone infection; high blood sugar slows wound healing and creates the ground for infection. For this reason we keep blood sugar under tight control starting before surgery and continue this monitoring uninterruptedly during and after the operation; this approach markedly reduces the risk of infection.

Frequently Asked Questions

If I have diabetes, is my bypass risk higher? It may increase the overall risk somewhat, but with tight blood sugar control and an experienced team this risk can largely be managed.

Do I need to get my blood sugar under control before surgery? Yes; having blood sugar at the best possible level before surgery directly affects the success of both the operation and the recovery process.

Why is bypass recommended instead of a stent in diabetic patients? In diffuse, multivessel disease, large trials have shown that the long-term results of bypass are superior to those of stenting.

Conclusion

Diabetes is an important factor affecting both the bypass decision and the treatment process; however, with correct preparation and tight blood sugar monitoring, our diabetic patients can also benefit from this operation safely and successfully.

If you have diabetes and would like an assessment of your coronary arteries, you can book an appointment.

References

1. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for Multivessel Revascularization in Patients with Diabetes. N Engl J Med. 2012;367(25):2375-2384.
2. Dangas GD, Farkouh ME, Sleeper LA, et al. Long-Term Outcome of PCI versus CABG in Insulin and Non-Insulin-Treated Diabetic Patients: Results From the FREEDOM Trial. J Am Coll Cardiol. 2014;64(12):1189-1197.