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In situ skeletonized gastroepiploic artery grafting in hemodialysis patients

Kohei Hachiro1, Takeshi Kinoshita2, Tomoaki Suzuki1

  • 1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan.

General Thoracic and Cardiovascular Surgery
|May 24, 2020
PubMed

Insights

Coronary artery bypass grafting in hemodialysis patients using the gastroepiploic artery showed acceptable short-term outcomes. This approach may be a viable option for patients with limited conduit availability.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Vascular Grafting

Background:

  • Coronary artery bypass grafting (CABG) strategies for hemodialysis patients lack standardization.
  • The gastroepiploic artery is a potential conduit for CABG, particularly in patients with limited options.

Purpose of the Study:

  • To investigate the postoperative outcomes of isolated CABG using the in situ skeletonized gastroepiploic artery in hemodialysis patients.
  • To evaluate the safety and efficacy of this surgical approach.

Main Methods:

  • Retrospective analysis of 49 hemodialysis patients who underwent isolated CABG with gastroepiploic artery grafting between 2002 and 2019.
  • Assessment of perioperative outcomes, including conversion rates, distal and proximal anastomoses, 30-day mortality, and early graft patency.

Main Results:

  • No conversions from off-pump to on-pump surgery were required.
  • The mean number of distal anastomoses was 3.6 per patient.
  • Thirty-day mortality was 4.1%, and the early patency rate of the gastroepiploic artery was 96.9%.
  • Survival rates free from death at 1, 5, and 10 years were 91.7%, 72.6%, and 32.5%, respectively.
  • Age and left ventricular ejection fraction <40% were independent predictors of mid-term mortality.

Conclusions:

  • The use of the in situ skeletonized gastroepiploic artery in CABG for hemodialysis patients yielded acceptable short- and mid-term outcomes.
  • This technique may reduce aortic manipulation time and represents an important option for CABG in hemodialysis patients with limited conduit availability.
Abstract

Keywords:
Gastroepiploic arteryHemodialysis patients

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