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Off-pump Coronary Artery Bypass Grafting in patients on chronic hemodialysis
S Osaka1, H Ohsawa, M Miyazawa
1Cardiovascular Center, Teikyo University Ichihara Hospital, Japan. shinichi-osaka@pop06.odn.ne.jp
Insights
Off-pump coronary artery bypass grafting (CABG) is feasible in patients undergoing chronic hemodialysis (HD). This study demonstrates successful outcomes using in situ arterial grafts in a small cohort of HD patients.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Grafting
Background:
- Off-pump coronary artery bypass grafting (CABG) is increasingly utilized but lacks extensive reporting in patients on chronic hemodialysis (HD).
- This study presents the surgical details and outcomes of CABG in patients with end-stage renal disease requiring chronic HD.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump CABG in patients on chronic hemodialysis.
- To describe the surgical techniques and graft choices for this specific patient population.
Main Methods:
- A retrospective review of 5 patients on chronic HD who underwent off-pump CABG between January 1998 and December 1999.
- Patients presented with unstable angina pectoris; indications included suitable coronary anatomy and high risk associated with cardiopulmonary bypass.
- Surgical approaches included median sternotomy and left anterior short thoracotomy, with a mean of 2.0 grafts per patient, primarily utilizing in situ arterial grafts.
Main Results:
- No operative deaths or complications were observed in the study cohort.
- Postoperative angiography confirmed 90% graft patency before hospital discharge.
- Mean follow-up of 17.2 months showed no recurrence of angina or cardiac symptoms.
Conclusions:
- Off-pump CABG utilizing in situ arterial grafts is a viable option for patients on chronic hemodialysis.
- Successful outcomes are contingent upon suitable coronary artery anatomy for grafting.
Background:
Off-pump Coronary Artery Bypass Grafting(CABG) has gained much support but has been scarcely reported in patients on chronic hemodialysis (HD). The details of CABG for such patients on chronic HD are presented.
Methods:
Between January 1998 and December 1999, off-pump CABG was performed in 5 patients on chronic HD. All patients presented with unstable angina pectoris. The indication for off-pump CABG was suitable coronary anatomy (N = 5) and expected high risks associated with cardiopulmonary bypass due to reoperation (N = 1) and impaired cerebral blood flow (N = 2). The approach was median sternotomy (N = 4) and left anterior short thoracotomy (N = 1). The mean graft number was 2.0 +/- 1.0 (range, 1-3). In situ arterial grafts were mainly used: the in situ left internal thoracic artery was used in four patients, the in situ right gastroepiploic artery in two, the in situ right internal thoracic artery in two, and the saphenous vein in two patients.
Results:
There were no deaths or complications. Nine of 10 grafts were confirmed fully patent by postoperative angiography before hospital discharge. In a mean follow-up of 17.2 months, no patients had developed recurrence of angina or any cardiac symptom.
Conclusion:
Off-pump CABG using in situ arterial grafts can be performed on patients on chronic hemodialysis subject to suitable anatomy of the target coronary arteries.