Perioperative Glycaemic Dynamics in Type 2 Diabetes Mellitus: Comparison of Minimally Invasive and Conventional Coronary Artery Bypass

Ivan S.  Dordiai; Lada O.  Sobanska; Lesia K.  Benkovska

doi:10.63181/ujcvs.2025.33(4).22-29

Ivan S. Dordiai State Institution of Science «Center of innovative healthcare technologies» State Administrative Department, Kyiv, Ukraine https://orcid.org/0000-0003-4475-2733
Lada O. Sobanska State Institution of Science «Center of innovative healthcare technologies» State Administrative Department, Kyiv, Ukraine https://orcid.org/0000-0002-0162-0442
Lesia K. Benkovska State Institution of Science «Center of innovative healthcare technologies» State Administrative Department, Kyiv, Ukraine https://orcid.org/0000-0003-3436-3128

DOI: https://doi.org/10.63181/ujcvs.2025.33(4).22-29

Keywords: сoronary artery disease, сardiac surgery, minimally invasive CABG or CABG, T2DM, CPB або cardiopulmonary bypass, perioperative management, inotropic support, metabolic stress, glucose, integral glycaemic indices

Abstract

Aim. To compare perioperative glycaemic dynamics and the need for inotropic support in patients with type 2 diabetes undergoing minimally invasive versus conventional coronary artery bypass grafting.

Materials and Methods. The study included 60 patients with multivessel coronary artery disease and type 2 diabetes mellitus not treated with insulin. All underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Group 1 (prospective, n=30) underwent minimally invasive CABG (MICS CABG) via left anterior thoracotomy; Group 2 (retrospective, n=30) underwent conventional CABG via sternotomy. Glycaemic levels were assessed perioperatively at six time points, and integral indices (mean AUC, AUC>10) were calculated. Statistical analyses included the Friedman test with post-hoc Wilcoxon comparisons and Spearman correlation for associations with clinical parameters.

Results. Completeness of revascularisation was comparable between groups: the completeness index was 0.95±0.138 in Group 1 and 0.94±0.127 in Group 2 (p=0.811). Operative (Group 1: 341.9±31.6 min; Group 2: 258.4±27.9 min) and perfusion times were longer in the minimally invasive group (p<0.001), reflecting greater technical complexity. However, the sternotomy group showed significantly higher postoperative glucose levels and a greater overall glycaemic load. Mean AUC was 8.3 (7.4-8.9) in Group 1 and 9.7 (8.4-11.1) in Group 2 (p<0.001), along with a longer time in clinically significant hyperglycaemia (AUC>10, p=0.01). These patients also required more frequent (p=0.021) inotropic support with dobutamine, with significantly higher dosing (p=0.018) and longer infusion duration (p=0.037). AUC>10 correlated positively with the mean dobutamine dose (p=0.42, p=0.01).

Conclusions. Minimally invasive CABG, while technically more demanding, provided equivalent revascularisation with reduced metabolic and haemodynamic stress compared with sternotomy. Integral glycaemic indices, particularly AUC>10, emerged as sensitive markers of metabolic stress and potential predictors of inotropic dependence, supporting their role in personalised perioperative management

References

Naito R, Miyauchi K. Coronary artery disease and type 2 diabetes mellitus. Int Heart J. 2017;58(4):475−480. https://doi.org/10.1536/ihj.17-191
Patsouras A, Farmaki P, Garmpi A et al. Screening and risk assessment of coronary artery disease in patients with type 2 diabetes: an updated review. In Vivo. 2019;33(4):1039−1049. https://doi.org/10.21873/invivo.11572
Wong ND, Sattar N. Cardiovascular risk in diabetes mellitus: epidemiology, assessment and prevention. Nat Rev Cardiol. 2023;20(10):685−695. https://doi.org/10.1038/s41569-023-00877-z
Godoy LC, Tavares CAM, Farkouh ME. Weighing coronary revascularization options in patients with type 2 diabetes mellitus. Can J Diabetes. 2020;44(1):78−85. https://doi.org/10.1016/j.jcjd.2019.08.002
Alsharif, A.; Alsharif, A.; Alshamrani, G.; Abu Alsoud, A.; Abdullah, R.; Aljohani, S.; Alahmadi, H.; Fuadah, S.; Mohammed, A.; Hassan, F.E. Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review. Clin. Pract. 2024, 14, 1842–1868. https://doi.org/10.3390/clinpract14050147
Sljivo A, Hadzimehmedagic A, Serdarevic M et al. Enhanced recovery and reduced complications with minimally invasive coronary artery bypass grafting compared to open sternotomy.ActaInformMed.2025;33(2):135−139. https://doi.org/10.5455/aim.2025.33.135-139
Huang Z, Zhang H, Huang Y et al. Association of time in range with postoperative wound healing in patients with diabetic foot ulcers. Int Wound J. 2021;19(6):1309−1318. https://doi.org/10.1111/iwj.13725
Dobson GP. Trauma of major surgery: a global problem that is not going away. Int J Surg. 2020; 81:47−54. https://doi.org/10.1016/j.ijsu.2020.07.017
Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis. 2021;13(3):1922-1944. https://doi.org/10.21037/jtd-20-1535
Gong Y, Ding T, Wang X et al. Minimally invasive vs conventional coronary bypass surgery for multivessel coronary disease. Ann Thorac Surg Short Rep. 2024;3(2):402−407. https://doi.org/10.1016/j.atssr.2024.10.024
Guangxin Z, Liqun C, Lin L et al. The efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) for patients with coronary artery diseases and diabetes: a single center retrospective study. J Cardiothorac Surg. 2024; 19:244. https://doi.org/10.1186/s13019-024-02717-8
Alzghoul H, Weimer J, Antigua A et al. Optimizing postoperative glucose management in CABG patients: exploring early transition to subcutaneous insulin. J Cardiovasc Dev Dis. 2024;11(11):348. https://doi.org/10.3390/jcdd11110348.
Agirbasli M. Influence of diabetes on CABG patency: targeting functional status after CABG in patients with DM. J Am Coll Cardiol. 2017;70(20):2604. https://doi.org/10.1016/j.jacc.2017.07.801