| Off-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysis-dependent renal failure. | |
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MedLine Citation:
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PMID: 19159849 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Patients with chronic dialysis-dependent end-stage renal disease are increasingly referred for coronary artery bypass grafting (CABG) and their early outcome is less favorable. Off-pump CABG (OPCAB) has achieved encouraging results in high-risk patients. Therefore, we designed this retrospective study to test the hypothesis that OPCAB reduced surgical risks in dialysis patients. METHODS: From January 2000 to December 2005, 294 dialysis-dependent patients received isolated CABG at the Washington Hospital Center. Among them, 168 underwent OPCAB (off-pump group), and 126, CABG with cardiopulmonary bypass (CPB) (on-pump group). The in-hospital outcomes were analyzed. RESULTS: The two groups were comparable in terms of preoperative characteristics. The Parsonnet's Bedside Score of the off-pump group was similar to that of the on-pump group (32.0 vs. 32.0, P=.57). The in-hospital mortality of the off-pump group was significantly lower than that of the on-pump group (5.4% vs. 11.9%, P=.04). Although the percentage of patients who received transfusions was similar, the on-pump group received more total transfusions. Logistic regression analysis revealed that use of CPB independently predicted in-hospital mortality [odds ratio (OR), 5.0; 95% confidence interval, 1.78-13.85; P<.01] and perioperative myocardial infarction (MI; OR, 5.1; 95% confidence interval, 1.18-22.40; P=.03). No significant difference in long-term survival at 4 years was absorbed between the two groups of hospital survivors. CONCLUSIONS: Our data suggest that OPCAB is a safe alternative to on-pump CABG in dialysis patients. Avoiding CPB resulted in less perioperative blood utilization, MI, and hospital mortality. |
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Authors:
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Li Zhang; Steven W Boyce; Peter C Hill; Xiumei Sun; Ann Lee; Elizabeth Haile; Jorge M Garcia; Paul J Corso |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Cardiovascular revascularization medicine : including molecular interventions Volume: 10 ISSN: 1878-0938 ISO Abbreviation: - Publication Date: 2009 Jan-Mar |
Date Detail:
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Created Date: 2009-01-22 Completed Date: 2009-03-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101238551 Medline TA: Cardiovasc Revasc Med Country: United States |
Other Details:
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Languages: eng Pagination: 12-6 Citation Subset: IM |
Affiliation:
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Department of Surgery, Washington Hospital Center, Washington, DC 20010-2975, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Transfusion Cardiopulmonary Bypass / adverse effects, mortality* Coronary Artery Bypass / mortality* Coronary Artery Bypass, Off-Pump / mortality* Coronary Artery Disease / complications, mortality, surgery* Hospital Mortality Humans Kaplan-Meiers Estimate Kidney Failure, Chronic / complications, mortality, therapy* Logistic Models Myocardial Infarction / etiology, mortality Odds Ratio Renal Dialysis / adverse effects, mortality* Retrospective Studies Risk Assessment Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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