Document Detail


Coronary artery bypass grafting in dialysis patients.
MedLine Citation:
PMID:  10543489     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To analyze the characteristic problems of coronary artery bypass grafting in patients with chronic renal failure. METHODS: Fifty-one consecutive dialysis patients who required isolated coronary bypass grafting over a 9-year period were studied retrospectively. RESULTS: Nine patients (18%) had emergent operation, 4 of whom had intraaortic balloon counterpulsation instituted preoperatively. A mean of 3.3 +/- 1.0 bypasses per patient were grafted; 14 patients (27%) had bypass with two arterial grafts, 13 (25%) of which used left internal mammary artery and gastroepiploic artery and one of which used bilateral internal mammary artery grafts. A mean of 4.2 +/- 2.6 coronary artery segments were calcific according to American Heart Association classification. Eight patients (16%) required operative modifications to avoid manipulating calcific plaques on the ascending aorta. Four patients (7.8%) died, and 15 had nonlethal complications. The actuarial survival rates in 47 hospital survivors at 1, 3, and 5 years were overall 89%, 84%, and 71%, respectively, and estimates for cardiac deaths 93%, 93%, and 82%, respectively. Cardiac event-free rates after coronary artery bypass grafting were 83% and 65% for 3- and 5-year periods, respectively. CONCLUSIONS: Calcification of coronary arteries and the ascending aorta is a serious problem in long-term dialysis patients. However using arterial grafts, preferentially, in situ, seems to provide a practical alternative to minimize manipulating the ascending aorta during coronary artery bypass grafting, with acceptable perioperative morbidity and mortality rates and long-term survival.
Authors:
Y Nakayama; R Sakata; M Ura; T A Miyamoto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  68     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-11-09     Completed Date:  1999-11-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1257-61     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamotoshi, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cause of Death
Coronary Artery Bypass*
Coronary Artery Disease / mortality,  surgery*
Emergencies
Female
Humans
Kidney Failure, Chronic / mortality,  surgery*
Kidney Function Tests
Male
Middle Aged
Myocardial Revascularization
Peritoneal Dialysis, Continuous Ambulatory*
Postoperative Complications / mortality
Renal Dialysis*
Retrospective Studies
Risk Factors
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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