Diabetic patients

Diabetic patients experience superior survival with less conventional CABG surgery

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heart bypass

Diabetic patients who undergo heart bypass surgery are living longer and have much better long-term outcomes when cardiothoracic surgeons use arteries rather than veins for the bypasses, according to a new study published online by The Annals of Thoracic Surgery.

Key findings in this study show more diabetic patients survive when only arteries are used for bypasses during coronary artery bypass grafting (CABG) surgery. Diabetic patients experience fewer long-term complications from total arterial revascularization (TAR)/CABG than from conventional CABG. TAR/CABG can be performed successfully by any well-trained cardiothoracic surgeon.

“Going into this study, we believed that diabetic patients would do better using total arterial techniques,” said James Tatoulis, MD, FRACS, from the Royal Melbourne Hospital in Australia. “But it was gratifying to actually prove it and also be able to document the significant magnitude of the difference.”

Dr. Tatoulis and colleagues in Melbourne examined more than 63,000 cardiac surgical cases from the Australian and New Zealand Society of Cardiothoracic Surgeons (ANZSCTS) Database. In their review, they identified 34,181 patients who underwent CABG surgery for the first time from 2001 to 2012. Of those, 2,017 were diabetic patients who had CABG using only arteries (TAR) and 1,967 diabetic patients who had conventional CABG, predominantly using veins.

This study showed that when TAR/CABG is used for diabetic patients, long-term survival improves significantly. For every 100 diabetic patients undergoing CABG surgery, four more will be alive at 10 years when arteries are used for the bypasses rather than just one arterial graft together with veins (82 vs. 78, respectively), explained Dr. Tatoulis.

A strong correlation exists between coronary artery disease (CAD) and diabetes. According to the American Heart Association, adults with diabetes are two to four times more likely to have heart disease than adults without diabetes. In addition, the American Diabetes Association estimates that 29.1 million Americans have diabetes, with 1.4 million more being diagnosed each year.

“With the incidence of diabetes increasing in the United States, happening together with the continued improvement in life expectancy, it is probable that there will be more and more diabetic patients requiring CABG surgery in the future,” said Dr. Tatoulis. “Thus, the superiority of TAR/CABG will assume progressive importance.”

Another important finding from the study was that TAR/CABG can be performed on diabetic patients without increasing the rate of complications, such as angina (chest pain), heart attacks, heart failure, and hospital readmissions.

CABG surgery has been performed for more than 50 years. In the US, it is one of the most common major surgeries, with almost 400,000 CABG surgeries performed each year, according to the US Centers for Disease Control and Prevention.

CABG surgery is designed to help restore blood flow to the hearts of patients with CAD. CAD is caused by a buildup of plaque (calcium, fat, cholesterol, etc.) in the walls of the arteries that supply blood to the heart and other parts of the body. During CABG surgery, a blood vessel is removed or redirected from one area of the body and placed around the narrowed area to “bypass” the blockages and restore blood flow to the heart muscle. This vessel is called a graft.

Dr. Tatoulis said the average conventional CABG surgery involves three to four grafts: one artery is usually used, along with vein grafts from the leg or thigh for the remaining new bypasses. In TAR/CABG surgery, only arteries are used.

Currently, only 5% of all patients in the US who undergo CABG surgery receive multiple arterial grafts, stated Dr. Tatoulis. “As a result, there is room for a much larger proportion of patients to have this type of coronary surgery and receive the benefits of a longer life, better quality of life, and reduced medical costs,” he said.

The study also confirmed that TAR is achievable and can be performed by any well-trained cardiothoracic surgeon. “TAR/CABG is definitely within each cardiothoracic surgeon’s ability and should be part of their repertoire,” explained Dr. Tatoulis

 

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Plugging leaky blood vessels to save vision

Red-Eye-1-200x300A new drug approach has been developed for safer clean-up of deformed blood vessels in the eye by a research team at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital in Toronto.

The growth of malformed blood vessels that can burst is a leading cause of vision loss in North America. Retinopathy and retina degeneration are associated with premature birth, with diabetes, and with increasing age.
Research just published by Dr. Andras Nagy and co-authors shows both safety and effectiveness in their bioengineered compound when treating retinopathy in mice. The therapeutic, which they called “Sticky-trap,” shuts down tiny deformed blood vessels in the eye without affecting healthy vessels in other sites of the body.

The research appears in EMBO Molecular Medicine, which published a separate editorial stating that the compound “holds great promise as a strategy that could be rapidly translated into clinical practice. […] We expect that Sticky-trap and future related molecules will have significant impact on the field of tumour biology in local control of recurrent disease. […]”

Dr. Nagy is a Senior Investigator at the Lunenfeld-Tanenbaum and holds a Canada Research Chair in Stem Cells and Regeneration. He is a Professor in the Department of Obstetrics and Gynacology at University of Toronto and an Investigator at the McEwen Centre for Regenerative Medicine. Co-authors include colleagues from University of California Los Angeles, The Scripps Research Institute (La Jolla CA), University of Toronto, and the Lunenfeld-Tanenbaum.

Selective action is key to safety
Like some other treatments for retinopathy, Sticky-trap is injected into the eye. The potential game-changer is Sticky-trap’s safety profile. It is stable and long-lasting once in the eye. If the compound gets into the circulation, it quickly inactivates — ensuring that it does not affect other blood vessels, tissues, and organs.
A problem in this research arena — called antiangiogenesis — has been finding a compound that is selective, closing off abnormal blood vessels only in the diseased organ while leaving all others intact. “That’s difficult, and it’s what makes this research high-risk as well as high-impact,” Dr. Nagy says.

Type 2 diabetes illustrates the challenge. “Patients with diabetic retinopathy are losing vision because blood vessels in their eyes overgrow, become deformed and burst, often tearing the retina in the process. Drugs that suppress the excess vessel formation in the eye could negatively affect healthy organs if they escape into the blood, causing kidney function problems, poor wound healing, and hypertension,” Dr. Nagy adds. These side effects are serious health threats that the Sticky-trap approach can avoid.

Advanced bioengineering
Over the nine years it took to bring the project to fruition, Dr. Nagy’s team used cutting-edge genetic and pharmacological techniques to engineer the new two-step biologics. Sticky-trap includes a binding component that attaches to the surface of cells, ensuring that it remains in place and is stable, as well as the biologically active component. “That’s important when a treatment involves injection directly into a diseased tissue,” says first author Dr. Iacovos Michael, a post-doctoral fellow in the Nagy lab.

“The longer-acting it is, the fewer injections a patient will need.” He adds that the project “is just the beginning for the establishment of a new class of pharmacological entity, ‘sticky’ biologics, characterized by localized, targeted activity. The same principle could be used to develop similar local-acting biologics for other conditions such as inflammatory and autoimmune diseases.”
Dr. Nagy is renowned for his work in stem cells, blood vessel biology, and creating genetic tools in cancer cells, among other areas. His team is also working on applications of the two step Sticky-trap for solid tumours.

Upon publication on May 6, Sticky-trap became available to biotech and pharmaceutical companies to adapt and develop.
“The significant advance in this approach is its built-in precision guidance system,” says Dr. Jim Woodgett, Director of the Lunenfeld-Tanenbaum. “Worldwide research efforts have developed powerful agents that can treat diseased tissues but if they cannot be steered to where they are needed, they can also cause collateral damage. The initial application to diabetic retinopathy shows proof-of-principle in a very important disease, but the approach can be adapted to other powerful drugs and diseases where localized activity is needed.”

Source: science daily