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[Blood purification after aorto-coronary bypass grafting for dialysis patients]
H Nakano1, T Shimakura, T Katsumata
1Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Japan.
Insights
Continuous veno-venous hemofiltration with hemodiafiltration (CVVHF + HDF) is the most effective method for managing fluid balance in dialysis patients undergoing coronary artery bypass grafting (CABG). This approach stabilizes circulation and maintains serum levels post-surgery.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Context:
- Aorto-coronary bypass grafting (CABG) presents unique perioperative challenges for patients requiring dialysis.
- Managing fluid balance and hemodynamic stability is crucial for successful surgical outcomes in this population.
Purpose:
- To evaluate the efficacy of different perioperative dialysis methods for patients undergoing CABG.
- To determine the optimal dialysis strategy for maintaining fluid balance and hemodynamic stability post-CABG.
Summary:
- Four dialysis patients received CABG, with perioperative management utilizing continuous ambulatory peritoneal dialysis (CAPD), extracorporeal ultrafiltration hemodialysis (ECUM + HD), or continuous veno-venous hemofiltration with hemodiafiltration (CVVHF + HDF).
- Intermittent hemodialysis was administered preoperatively, and hemodialysis was used intraoperatively with extracorporeal circulation.
- CVVHF + HDF demonstrated superior ability to stabilize circulation and maintain fluid and serum balance (BUN, Cr) postoperatively compared to CAPD and ECUM + HD.
Impact:
- CVVHF + HDF is identified as the most favorable method for stable fluid balance management in uremic patients after CABG.
- This finding can guide clinical practice in optimizing perioperative care for dialysis-dependent patients undergoing major cardiac surgery.
Abstract:
Four dialysis patients received aorto-coronary bypass grafting (CABG) at Fukuyama cardiovascular hospital from April 1989 to March 1992. We employed continuous ambulatory peritoneal dialysis (CAPD) in two cases, hemodialysis with extracorporeal ultrafiltration method (ECUM + HD) in one case and hemodiafiltration with continuous veno-venous hemofiltration (CVVHF + HDF) in one case for perioperative management. In each cases, intermittent HD was undergone during 4 days before operation. Intraoperatively, HD was used together with extracorporeal circulation. Blood pressure in the postoperative course changed more frequently in CAPD cases than ECUM + HD or CVVHF + HDF case. Especially, CVVHF + HDF stabilized the movement of circulation and kept balance of serum BUN, Cr after the operation (BUN; 27.2 +/- 6.3, Cr; 5.0 +/- 0.6). We concluded that CVVHF + HDF would be the most favorable method to maintain the fluid balance stably for the uremic patients after CABG.