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Coronary artery bypass grafting in patients with dialysis-dependent renal failure
S Higashiue1, Y Nishimura, M Shinbo
1Department of Cardiovascular Surgery, Kishiwada Tokushukai General Hospital, Osaka, Japan.
Insights
Coronary artery bypass grafting (CABG) in dialysis patients has acceptable operative risk. Utilizing beating heart bypass may improve early outcomes and reduce mortality in this high-risk group.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Oncology
Background:
- Dialysis patients often have complex cardiovascular disease requiring surgical intervention.
- Coronary artery bypass grafting (CABG) in this population presents unique challenges and risks.
- Understanding short- and long-term outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the short- and long-term results of CABG in patients dependent on chronic dialysis.
- To assess the impact of different surgical techniques, including beating heart bypass, on outcomes.
- To determine the overall safety and efficacy of CABG in this specific patient cohort.
Main Methods:
- Retrospective review of 73 consecutive dialysis-dependent patients undergoing CABG.
- Analysis of operative mortality (30-day mortality) and survival rates.
- Comparison of outcomes between conventional cardiopulmonary bypass and beating heart bypass techniques.
Main Results:
- Overall operative mortality was 4.1%, with causes linked to cardiopulmonary bypass.
- No hospital deaths occurred in the final 29 operations utilizing beating heart bypass.
- Actual survival rates declined to 45% at 70 months, primarily due to non-cardiac late deaths.
Conclusions:
- CABG can be undertaken in dialysis patients with acceptable operative risk.
- The introduction of beating heart bypass demonstrated promising early results with no hospital mortality in the observed group.
- Further investigation into the extended application of beating heart bypass is warranted to potentially improve outcomes for dialysis patients undergoing CABG.
Abstract:
The aim of this study was to define short- and long-term results of coronary artery bypass grafting (CABG) in dialysis patients. A retrospective review was carried out on 73 consecutive patients dependent on chronic dialysis who underwent CABG. In 63 isolated CABGs, 9 operations were performed under normal beating heart because of severe atherosclerotic changes in the ascending aorta or carotid arteries. The operative mortality (30 days' mortality) was 4.1%, and causes of death were closely related to cardiopulmonary bypass use. In the last 29 operations after introduction of the beating heart bypass, no hospital deaths occurred. The actual survival rates dropped to 45% at 70 months mainly for noncardiac late death. CABG for dialysis patients as undertaken with an acceptable operative risk. Extended application of beating heart bypass to these patients may produce further positive early results.