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Coronary artery bypass grafting in dialysis patients
H Tanaka1, K Suzuki, T Narisawa
1Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama, 227-8501, Japan.
Insights
Continuous hemofiltration effectively manages fluid balance in dialysis patients undergoing cardiac surgery. Off-pump bypass with arterial grafting offers a viable technique for calcified aortas, simplifying patient care.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Background:
- Dialysis patients present unique challenges in cardiac surgery, specifically fluid-electrolyte management and managing severely calcified aortas.
- Traditional cardiopulmonary bypass can exacerbate fluid overload in renal impairment.
- Calcified aortas pose technical difficulties for cannulation and aortic manipulation during bypass.
Purpose of the Study:
- To evaluate the efficacy of continuous hemofiltration for water-electrolyte control in dialysis patients undergoing coronary artery bypass grafting.
- To assess the feasibility and outcomes of off-pump coronary artery bypass grafting with arterial grafting in patients with calcified aortas.
Main Methods:
- Coronary artery bypass grafting (CABG) was performed in 12 patients: 9 with extracorporeal circulation (pump) and 3 off-pump.
- Continuous hemofiltration was utilized for fluid management in pump cases (average 3.9 days).
- Arterial grafting was the primary technique used in both pump (1.3 grafts/pt) and off-pump (1.7 grafts/pt) procedures.
Main Results:
- Continuous hemofiltration was easily implemented with minimal hemodynamic compromise.
- Off-pump bypass cases were managed effectively with conventional hemodialysis.
- Grafting success rates were comparable, with arterial grafts predominantly used.
Conclusions:
- Continuous hemofiltration provides effective hemodynamic stability and fluid control for dialysis patients during cardiac surgery.
- Off-pump bypass, combined with arterial grafting and conventional hemodialysis, presents a safe and effective strategy for managing calcified aortas in this population.
Objective:
In dialysis patients, there are two issues to consider, water-electrolyte control and a bypass technique for a calcified aorta. We used continuous hemofiltration for water-electrolyte control and an off-pump bypass with arterial grafting for a calcified aorta.
Methods:
We performed coronary artery bypass grafting with extracorporeal circulation in 9 cases and without extracorporeal circulation (off-pump bypass) in 3 cases. In 6 cases, the operation was urgent, and in 6 cases the operation was elective.
Results:
An average of 3.2 grafts/pt, (the arterial graft: 1.3 grafts/pt) was performed in the pump cases. In the off-pump bypass cases we used arterial grafting only (1.7 grafts/pt). We had 1 early death (sudden death) and 1 hospital death (SLE encephalopathy). One late death due to cerebral bleeding occurred at 2 years later. We used continuous hemofiltration for 2 to 11 days (average 3.9 days) in the pump cases. The off-pump cases could be controlled by conventional hemodialysis.
Conclusion:
Continuous hemofiltration was very easily set up with less interference to the hemodynamics. Using an arterial graft with off-pump bypass, an aortic no-touch technique and water control with conventional hemodialysis were possible.