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Coronary artery bypass grafting for hemodialysis-dependent patients
H Hirose1, A Amano, A Takahashi
1Department of Cardiovascular Surgery, Kobari-General Hospital, Chiba, Japan. genex@nifty.com
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Patients undergoing coronary artery bypass grafting (CABG) with end-stage renal disease requiring hemodialysis experienced longer hospital stays and higher in-hospital mortality. However, long-term cardiac event rates were similar to controls after successful surgery.
Area of Science:
- Cardiology
- Nephrology
- Cardiovascular Surgery
Background:
- End-stage renal disease (ESRD) patients have a high risk of coronary atherosclerosis.
- Coronary artery bypass grafting (CABG) is a treatment option for these patients.
Purpose of the Study:
- To evaluate the perioperative and long-term outcomes of CABG in patients dependent on hemodialysis.
- To compare outcomes between hemodialysis-dependent patients and a control group.
Main Methods:
- Retrospective analysis of isolated CABG cases at Shin-Tokyo Hospital (1993-2000).
- Comparison of preoperative, perioperative, and follow-up data between hemodialysis patients (n=37) and control patients (n=1,639).
Main Results:
- Hemodialysis patients had longer postoperative intubation, ICU stay, and hospital stay.
- In-hospital mortality was higher in the hemodialysis group (5.4%) versus controls (0.6%).
- 3-year survival (excluding hospital mortality) and 3-year cardiac event-free rates were comparable between groups after successful revascularization.
Conclusions:
- Patients on chronic hemodialysis undergoing CABG face increased risks of prolonged hospitalization and in-hospital death.
- Successful CABG in hemodialysis patients can lead to effective long-term control of cardiac events.
- Higher long-term mortality in hemodialysis patients may be linked to the underlying renal disease.
Abstract:
Patients with end-stage renal disease carry a risk of coronary atherosclerosis. This study was performed to evaluate the perioperative and remote data of coronary artery bypass grafting (CABG) in hemodialysis dependent patients. We retrospectively analyzed the results of isolated CABG performed at Shin-Tokyo Hospital between June 1, 1993 and May 31, 2000. Preoperative, perioperative, and follow-up data of the patients on hemodialysis (Group HD, n = 37) were collected and compared with those of control patients (Group C, n = 1,639). Group HD consisted of 26 males and 11 females with a mean age of 59.9 +/- 8.1 years, and the mean number of bypasses was 2.5 +/- 1.1. Group HD had a longer postoperative intubation time, ICU stay, and hospital stay than Group C. The postoperative major complication rate in Group HD (18.9%) was not significantly different from that in Group C (11.3%). However, the inhospital mortality rate in Group HD (5.4%) was higher than Group C (0.6%). At the mean follow-up of 2.4 years, the actuarial 3-year survival of Groups HD and C were 90.6% and 97.6%, respectively (p < 0.001), excluding hospital mortality. The actuarial 3-year cardiac event-free rates were 84.3% in Group HD and 88.8% in Group C, showing no difference. Patients on chronic hemodialysis carry a significant risk of prolonged inhospital care and hospital death. Once successful surgical revascularization was completed, their long-term cardiac events could be controlled as effectively. The increased distant death rates was probably associated with the nature of renal disease.