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[Emergency coronary artery bypass grafting in dialysis patients]
1Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan.
Insights
Emergency coronary artery bypass surgery outcomes varied for chronic hemodialysis patients. Surgical modifications and perioperative management, including arterial grafts and hemofiltration, proved beneficial for this high-risk group.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Context:
- Emergency coronary artery bypass grafting (CABG) presents unique challenges in patients with chronic kidney disease requiring hemodialysis.
- Preoperative cardiogenic shock and the need for mechanical circulatory support (Intra-Aortic Balloon Pump [IABP] or Percutaneous Cardiopulmonary Support [PCPS]) were significant factors in the non-dialysis group.
- Chronic hemodialysis patients often have complex comorbidities, including calcified aorta and potential neurological complications, necessitating tailored surgical approaches.
Purpose:
- To evaluate the outcomes of emergency coronary artery bypass surgery in patients undergoing chronic hemodialysis.
- To compare the results between non-dialysis and chronic hemodialysis patient groups undergoing emergency CABG.
- To assess the efficacy of specific surgical modifications and perioperative management strategies in hemodialysis patients.
Summary:
- Nineteen patients underwent emergency CABG, including five on chronic hemodialysis. The non-dialysis group (14 patients) experienced a 29% mortality rate, primarily due to low output syndrome (LOS) in patients with preoperative cardiogenic shock requiring IABP or PCPS.
- The chronic hemodialysis group (5 patients) had a 40% mortality rate, with deaths attributed to arrhythmia and SLE encephalopathy, but not LOS. These patients received arterial in situ grafts and postoperative continuous hemofiltration.
- Surgical modifications and perioperative management, such as arterial grafting and hemofiltration, were deemed highly beneficial for chronic hemodialysis patients undergoing emergency CABG.
Impact:
- The study highlights the feasibility and potential benefits of specific surgical techniques and intensive perioperative care for chronic hemodialysis patients undergoing emergency CABG.
- Findings suggest that tailored management can mitigate risks associated with emergency cardiac surgery in this vulnerable population.
- This research provides valuable insights for optimizing outcomes in patients with end-stage renal disease requiring urgent cardiovascular intervention.
Abstract:
Emergency coronary artery bypass surgery was performed in nineteen patients including five chronic hemodialysis patients. In fourteen patients (non-dialysis patients), ten patients required preoperative IABP and four required PCPS for cardiogenic shock. Four patients died (29%); three from LOS and one from sudden death. Most of them (3/4) were preoperative cardiogenic shock. In other five patients (dialysis patients), four patients had conventional CABG, while one received off-pump bypass surgery for calcified aorta and brain complication. All five patients received arterial in situ conduit and continuous hemofiltration in the early postoperative period for controlling water and electrolyte. Two patients died (40%); one from arrhythmia and one from deterioration of original disease (SLE encephalopathy) but no one died from LOS. These methods of surgical modification and perioperative management for chronic hemodialysis patients are considered very useful.