Summary
Diabetes has significant implications for cardiac surgery. It is not only a major risk factor for coronary heart disease but also increases the risk for cerebrovascular complications during heart surgery. Surgical technique is pivotal for the outcome. “Off-pump“ surgery carries a lower risk for stroke than conventional heart surgery. When a stroke happens, diabetes plays also a major role for the final outcome. Initial blood glucose levels during a stroke and final outcome are highly correlated. Consequently, patients with ischemic stroke after cardiac surgery should be treated according to the current criteria for stroke treatment. This includes strict monitoring of blood glucose level and avoidance of hypo- as well as hyperglycemia.
Zusammenfassung
Das Vorliegen eines Diabetes mellitus hat weitreichende Konsequenzen für die Herzchirurgie. Der Diabetes ist nicht nur ein Risikofaktor für die koronare Herzerkrankung, sondern erhöht auch das Risiko für zentralnervöse Komplikationen bei der koronaren Herzchirurgie. Unter anderem wird das Komplikationsrisiko durch die Operationstechnik bestimmt. „Off-pump“-koronare Herzchirurgie ist mit einer niedrigeren Rate von Schlaganfällen assoziiert. Treten zerebrovaskuläre Komplikationen auf, spielt der Diabetes eine prognosebestimmende Rolle. Der initiale Blutzuckerspiegel und das funktionelle Ergebnis sind nach einem Schlaganfall eng miteinander korreliert. Als Konsequenz ist zu fordern, dass die Behandlungsoptionen beim akuten ischämischen Schlaganfall nach Koronarinterventionen auch und gerade bei Patienten mit Diabetes mellitus den allgemein gültigen Behandlungskriterien entsprechen müssen. Zwingend erforderlich sind sofort beginnendes Monitoring der Blutzuckerwerte, strikte Hypo- und Hyperglykämievermeidung und akute Stoffwechselrekompensation. Die Datenlage spricht für den Erfolg einer akut beginnenden normnahen (80–120 mg/dl) Stoffwechselführung.
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Fetter, M. Der herzkranke Diabetiker und zerebrovaskuläre Erkrankungen. Clin Res Cardiol 95 (Suppl 1), i59–i62 (2006). https://doi.org/10.1007/s00392-006-1104-1
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DOI: https://doi.org/10.1007/s00392-006-1104-1