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Analysis of the Use of Extracorporeal Circulation on the In-Hospital Outcomes of Dialytic Patients Who Underwent
Matheus Miranda1, João Nelson Rodrigues Branco1, Guilherme Flora Vargas1
1Hospital do Rim e Hipertensão, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
Insights
Myocardial revascularization surgery without extracorporeal circulation (ECC) in dialysis patients leads to lower morbidity and shorter intensive care unit stays. However, mortality rates remain unchanged between the two surgical techniques.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Background:
- Myocardial revascularization surgery is crucial for dialysis patients with multivessel coronary disease.
- Extracorporeal circulation (ECC) use during surgery is associated with increased morbidity in this high-risk population.
- Dialysis patients undergoing coronary artery bypass grafting face significant perioperative challenges.
Purpose of the Study:
- To compare in-hospital outcomes of myocardial revascularization with and without extracorporeal circulation in dialysis patients.
- To identify differences in postoperative complications and resource utilization between the two surgical approaches.
Main Methods:
- A unicentric study included 102 consecutive dialysis patients undergoing myocardial revascularization between 2007 and 2014.
- Patients were divided into two groups: those who underwent surgery with ECC and those without ECC.
- Outcomes assessed included need for blood products, inotropic support, vasoactive drugs, mechanical ventilation duration, extubation rates, infection rates, ICU stay, and mortality.
Main Results:
- The group without ECC required fewer revascularizations, blood components, and inotropic support.
- Patients undergoing surgery without ECC experienced significantly lower rates of vasoactive drug use, shorter mechanical ventilation times, higher operating room extubation rates, reduced infection rates, and shorter ICU stays.
- No statistically significant difference in mortality was observed between the ECC and no-ECC groups.
Conclusions:
- Myocardial revascularization without ECC in dialysis patients is associated with reduced perioperative morbidity compared to surgery with ECC.
- The absence of ECC during myocardial revascularization in dialysis patients improves postoperative recovery and resource utilization.
- While morbidity is reduced, ECC use does not impact overall mortality in this patient cohort.
Background:
Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients.
Objectives:
To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization.
Methods:
Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014.
Results:
Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups.
Conclusion:
Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.
