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Published on: March 27, 2018
Coronary bypass procedures in patients with renal artery stenosis
Vedat Erentug1, Nilgün Bozbuga, Adil Polat
1Kosuyolu Heart and Research Hospital, Istanbul, Turkey. drvedat2002@yahoo.com
Insights
Patients with renal artery stenosis undergoing coronary artery bypass grafting (CABG) had a low incidence and manageable outcomes. While simultaneous renal artery stenosis correction is often unnecessary, individualized strategies are crucial for renovascular disease management.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Renal artery stenosis (RAS) is a significant comorbidity in patients requiring cardiovascular interventions.
- Coronary artery bypass grafting (CABG) in patients with RAS presents unique management challenges.
Purpose of the Study:
- To evaluate the outcomes of patients with renal artery stenosis who underwent myocardial revascularization.
- To assess the necessity and impact of concomitant renal artery stenosis correction during CABG.
Main Methods:
- Retrospective analysis of 18 patients with RAS undergoing CABG between 1996 and 2003.
- Evaluation of preoperative and postoperative renal function (creatinine levels).
- Comparison of on-pump versus off-pump CABG procedures.
Main Results:
- Overall incidence of RAS among CABG patients was 0.15%.
- One mortality and two patients required postoperative hemodialysis.
- Postoperative creatinine levels showed a trend of increase, with some patients requiring inotropic support or diuretics.
Conclusions:
- Concomitant correction of renal artery stenosis during CABG is typically not required.
- Individualized treatment strategies considering renovascular disease principles are essential.
- Careful perioperative management is necessary for patients with RAS undergoing CABG.
Background And Aim Of The Study:
We present our experience on patients with renal artery stenosis undergoing myocardial revascularization procedures.
Methods:
Eighteen patients with varying degrees of renal artery stenosis were operated for coronary artery bypass grafting between 1996 and 2003. The overall incidence was 0.15%. There were nine male and nine female patients with a mean age of 62 +/- 8.2 (40-72 years). Four had bilateral and eight had significant unilateral (>50%) renal artery stenoses. Preoperatively, three patients had renal arterial intervention (stenting), and one patient was on hemodialysis. The mean preoperative creatinine value was 2.6 +/- 2.7 mg/dL (range 0.7 to 9.3). The patients were followed medically: two patients underwent off-pump coronary bypass grafting and the others were operated on-pump.
Results:
There was only one mortality and two patients required hemodialysis postoperatively. The postoperative mean creatinine values were 3.4 +/- 4.9 mg/dL (range 1.0 to 12.5). No electrolyte imbalances were noted except that one case revealed a transient metabolic acidosis. Five patients required inotropic support with dopamine and two needed diuretic infusions. Only five patients demonstrated a refractory hyper tensive period postoperatively.
Conclusions:
The concomitant correction of renal artery stenosis with CABG is usually not necessary, but the principles for renovascular diseases must be kept in mind and individually oriented strategies must be planned.
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