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Published on: September 15, 2023
Does myocardial revascularization with multiple arterial grafts improve the prognosis of dialysis patients?
Hiroyuki Tanaka1, Takashi Narisawa, Takanobu Mori
1Department of Thoracic Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan. h.tanaka@showa-university-fujigaoka.gr.jp
Insights
Multiple arterial grafts in myocardial revascularization show promising short-term outcomes for dialysis patients, potentially improving cardiac death survival rates. However, overall survival was not significantly different due to non-cardiac deaths.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Oncology
Background:
- Dialysis patients face increased cardiovascular risks.
- Myocardial revascularization aims to improve outcomes in this high-risk group.
Purpose of the Study:
- To evaluate if multiple arterial grafts improve prognosis in dialysis patients undergoing coronary artery bypass grafting.
- To compare short-term and long-term results of multiple arterial grafts versus single arterial grafts with vein grafts.
Main Methods:
- Retrospective analysis of 20 dialysis patients undergoing coronary artery bypass grafting.
- Patients divided into two groups: Group A (≥2 arterial grafts) and Group B (1 internal thoracic artery + vein grafts).
- Comparison of surgical outcomes, operative risk, and survival rates (overall and cardiac-specific).
Main Results:
- No significant differences in patient profiles between groups.
- Group A had a higher mean arterial graft number (2.2 vs. 1.0).
- No mediastinitis or brain complications; Group A had no operative deaths versus one in Group B.
- 55-month actuarial survival: Group A (0.53 overall, 0.80 cardiac) vs. Group B (0.42 overall, 0.53 cardiac).
- Cardiac death survival was better in Group A, but not statistically significant.
Conclusions:
- Myocardial revascularization with multiple arterial grafts offers good short-term results for dialysis patients.
- This approach may enhance long-term survival related to cardiac death.
- Overall survival differences were not significant due to a high rate of non-cardiac mortality in the study cohort.
Abstract:
In the present study it was examined whether myocardial revascularization with multiple arterial grafts improves the prognosis of dialysis patients. The 20 subjects underwent coronary artery bypass grafting over 2 vessels (extra-corporeal circulation in 11 patients, off-pump bypass in 9 patients) and were divided into 2 groups according the number of arterial grafts. Group A consisted of 9 patients in whom more than 2 arterial grafts were used and Group B, 11 patients requiring 1 internal thoracic artery and additional saphenous vein grafts. The surgical procedure was examined, as well as the short-term and long-term results of both groups. There were no differences in the profiles of the 2 groups. The mean arterial graft number in group A was 2.2+/-0.6 and 1.0+/-0.0 in group B. There was neither mediastinitis nor brain complication in either group. There were no operative deaths in group A and 1 in group B. The 55-month actuarial survival rate including all deaths, and estimated by cardiac deaths, was, respectively, 0.53+/-0.21 and 0.80+/-0.18 in group A and 0.42+/-0.21 and 0.53+/-0.23 in group B. The survival rate estimated by cardiac death in group A was better, but there was not a significant difference. Myocardial revascularization with multiple arterial grafts for dialysis patients had good short-term results without increased operative risk and may improve the long-term results related to cardiac death. However, there was no significant difference in survival including all deaths because of the numerous non-cardiac deaths.
