Related Experiment Videos
[Coronary artery bypass graft surgery in dialysis patient]
Y Sawada1, T Morimoto, N Matsuyama
1Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan.
Insights
Coronary artery bypass graft surgery (CABG) in long-term hemodialysis patients shows acceptable outcomes. CABG offers symptom relief and survival rates comparable to other dialysis patients.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Oncology
Context:
- Severe coronary artery disease is prevalent in long-term hemodialysis patients.
- Optimal surgical strategies for this high-risk group remain debated.
- Coronary artery bypass graft surgery (CABG) is a potential treatment option.
Purpose:
- To evaluate the operative outcomes of CABG in patients undergoing long-term hemodialysis.
- To assess the hospital mortality, morbidity, and long-term survival after CABG in this population.
Summary:
- A cohort of 16 long-term hemodialysis patients underwent CABG over ten years.
- Hospital mortality was 12.5%, with major complications occurring in 25%.
- Actuarial survival at 3, 5, and 7 years was 68.8%, 57.3%, and 28.6%, respectively, with symptom relief in survivors.
Impact:
- CABG can be performed with acceptable morbidity and mortality in dialysis patients.
- The procedure provides effective symptom relief for angina.
- Survival rates appear comparable to or better than non-operated dialysis patients with coronary artery disease.
Abstract:
To determine the operative outcome of coronary artery bypass graft surgery (CABG) for severe coronary artery disease in long-term hemodialysis patients, we analyzed a group of 16 patients who underwent CABG over a ten-year period in our institution. Hospital mortality was 12.5% (2 of 16 patients). These two patients died of ischemic colitis and perioperative myocardial infarction, respectively. There were five late deaths: one patient died from myocardial infarction, one from uremia, one from gastro-intestinal bleeding, one from gastric cancer and one from unknown cause. There were four significant postoperative complications (morbidity 25%), consisted of one pulmonary tuberculosis, one sternal dehiscence secondary to mediastinitis, one mediastinal hematoma secondary to late bleeding from the LITA dissection area and one A-V shunt trouble. Graft patency rate within the first two months was 93% (30 to 42 in 13 patients). Hospital survivors experienced complete relief from angina. Actuarial survival was 68.8% at 3 years, 57.3% at 5 years and 28.6% at 7 years. This rate is not significantly different from the survival of all dialysis patients, but seems to be better than that of dialysis patients with not operated coronary artery disease. We concluded that CABG in dialysis patients can be accomplished with acceptable morbidity and mortality and effective relief of symptoms.