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J Thorac Cardiovasc Surg 2008;136:639-640
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Harold L. Lazar (Boston, Mass). In their study, Dr Halkos and colleagues found that an elevated preoperative HbA1c level was associated with a significant increase in mortality and morbidity. This is not surprising because patients with an elevated HbA1c had a higher incidence of preoperative renal failure, strokes, peripheral vascular disease, and diffuse coronary artery disease, which required more grafts. All of these factors are independently known to be predictive of adverse outcomes after bypass surgery.

My first question is whether an elevated HbA1c is a marker of advanced diabetic end-organ disease or does it really represent poor intraoperative glycemic control? Did you actually measure the perioperative glucose values between the high and low HbA1c groups to see whether or not your protocols actually achieved tight glycemic control in the elevated HbA1c group, and did the patients with elevated HbA1c levels who had lower perioperative glucose values have decreased morbidity and mortality?

Dr Halkos. Let me first start by addressing the question regarding tight intraoperative glycemic control. We did not collect those data because they were not accessible to us regarding the blood glucose levels in the . . . [Full Text of this Article]