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Thorac Cardiovasc Surg 2008; 56(7): 412-417
DOI: 10.1055/s-2008-1038670
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Outcome of Off-Pump Coronary Artery Bypass in Renal Dialysis Patients

J.-F. Liu1 , C.-H. Lin2 , 3 , C.-H. Chua2 , S.-S. Chiang3 , 4 , H.-F. Hung3 , 5 , M.-J. Lu2 , 3 , C.-R. Hung2
  • 1Cardiology, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan – Republic of China
  • 2Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan – Republic of China
  • 3College of Medicine, Fu Jen Catholic University, Taipei, Taiwan – Republic of China
  • 4Nephrology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan – Republic of China
  • 5Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan – Republic of China
Further Information

Publication History

received Nov. 11, 2007

Publication Date:
22 September 2008 (online)

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Abstract

Background: Renal dialysis patients are a subgroup at major operative risk when undergoing coronary artery bypass grafting (CABG). Even though CABG without cardiopulmonary bypass (CPB) has decreased the surgical risk and provided good short-term results, the long-term survival seems uncertain. We report here on the long-term outcome of CABG without CPB in renal dialysis patients. Methods: From 1998 to 2002, 44 renal dialysis patients underwent elective CABG without CPB, including 17 minimally invasive direct coronary artery bypass (MIDCAB) and 27 off-pump CABG (OPCAB) procedures. There were 5 one-vessel, 12 two-vessel and 27 multi-vessel coronary artery disease patients, who mainly had left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) grafting with an additional saphenous vein graft to non-LAD coronaries. Results: All 44 patients were followed up for 44.4 ± 31.2 months. Three (6.8 %) surgical deaths within 30 days occurred and 25 late mortalities happened over a period of 2 – 79 months. The 5-year cumulative rate of total survival is 38.2 % and the freedom from cardiac death is 70.9 %. Using hazard analysis, old age (> 60 years) and incomplete coronary revascularization was found to significantly affect the total survival. Conclusions: CABG without CPB provided an acceptable surgical mortality and morbidity. The high incidence of non-cardiac death associated with dialysis complications had an adverse impact on the overall outcome. The LITA bypass operation method combined with intensive care for dialysis complications would hopefully fulfill the goal to improve the short- and long-term results in this subgroup.

Key words

CABG without CPB - MIDCAB - OPCAB - renal dialysis - uremic - coronary bypass surgery

References

  • 1 Franga D L, Kratz J M, Crumbley A J, Zellner J L, Stroud M R, Crawford F A. Early and long-term results of coronary artery bypass grafting in dialysis patients.  Ann Thorac Surg. 2000;  70 813-818
    CrossrefPubMedSearch in Google Scholar
  • 2 Blakeman B P, Sullivan H J, Foy B K, Sobotka P A, Pifarre R. Internal mammary artery revascularization in the patient on long-term renal dialysis.  Ann Thorac Surg. 1990;  50 776-778
    PubMedSearch in Google Scholar
  • 3 Hannan E L, Racz M J, Walford G, Jones R H, Ryan T J, Bennett E. et al . Long-term outcomes of coronary-artery bypass grafting versus stent implantation.  N Engl J Med. 2005;  352 2174-2183
    CrossrefPubMedSearch in Google Scholar
  • 4 Ahmed W H, Shubrooks S J, Gibson C M, Baim D S, Bittl J A. Complications and long-term outcome after percutaneous coronary angioplasty in chronic hemodialysis patients.  Am Heart J. 1994;  128 252-255
    CrossrefPubMedSearch in Google Scholar
  • 5 Kahn J K, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Hartzler G O. Short- and long-term outcome of percutaneous transluminal coronary angioplasty in chronic dialysis patients.  Am Heart J. 1990;  119 484-489
    CrossrefPubMedSearch in Google Scholar
  • 6 Opsahl J A, Husebye D G, Helseth H K, Collins A J. Coronary artery bypass surgery in patients on maintenance dialysis: long-term survival.  Am J Kidney Dis. 1988;  12 271-274
    PubMedSearch in Google Scholar
  • 7 Batiuk T D, Kurtz S B, Oh J K, Orszulak T A. Coronary artery bypass operation in dialysis patients.  Mayo Clin Proc. 1991;  66 45-53
    PubMedSearch in Google Scholar
  • 8 Jahangiri M, Wright J, Edmondson S, Magee P. Coronary artery bypass graft surgery in dialysis patients.  Heart. 1997;  78 343-345
    PubMedSearch in Google Scholar
  • 9 Owen C H, Cummings R G, Sell T L, Schwab S J, Jones R H, Glower D D. Coronary artery bypass grafting in patients with dialysis-dependent renal failure.  Ann Thorac Surg. 1994;  58 1729-1733
    PubMedSearch in Google Scholar
  • 10 Lichtenberg A, Klima U, Paeschke H, Pichlmaier M, Ringes-Lichtenberg S, Walles T. et al . Impact of multivessel coronary artery disease on outcome after isolated minimally invasive bypass grafting of the left anterior descending artery.  Ann Thorac Surg. 2004;  78 487-491
    CrossrefPubMedSearch in Google Scholar
  • 11 Lattouf O M, Puskas J D, Thourani V H, Noora J, Kilgo P D, Guyton R A. Does the number of grafts influence surgeon choice and patient benefit of off-pump over conventional on-pump coronary artery revascularization in multivessel coronary artery disease?.  Ann Thorac Surg. 2007;  84 1485-1494
    CrossrefPubMedSearch in Google Scholar
  • 12 Ariyoshi T, Eishi K, Yamachika S, Hazama S, Takai H, Odate T. et al . Perioperative and mid-term results of coronary bypass surgery in patients undergoing chronic dialysis.  Ann Thorac Cardiovasc Surg. 2006;  12 257-264
    PubMedSearch in Google Scholar
  • 13 Cohen H A, Zenati M, Smith A J, Lee J S, Chough S, Jafar Z. et al . Feasibility of combined percutaneous transluminal angioplasty and minimally invasive direct coronary artery bypass in patients with multivessel coronary artery disease.  Circulation. 1998;  98 1048-1050
    PubMedSearch in Google Scholar
  • 14 Leimgruber P P, Roubin G S, Hollman J, Cotsonis G A, Meier B, Douglas J S. et al . Restenosis after successful coronary angioplasty in patients with single-vessel disease.  Circulation. 1986;  73 710-717
    PubMedSearch in Google Scholar
  • 15 Rinehart A L, Herzog C A, Collins A J, Flack J M, Ma J Z, Opsahl J A. A comparison of coronary angioplasty and coronary artery bypass grafting outcomes in chronic dialysis patients.  Am J Kidney Dis. 1995;  25 281-290
    CrossrefPubMedSearch in Google Scholar
  • 16 Koyanagi T, Nishida H, Endo M, Koyanagi H. Coronary artery bypass grafting in chronic renal dialysis patients: intensive perioperative dialysis and extensive usage of arterial grafts.  Eur J Cardiothorac Surg. 1994;  8 505-507
    CrossrefPubMedSearch in Google Scholar
  • 17 Nakayama Y, Sakata R, Ura M, Miyamoto T A. Coronary artery bypass grafting in dialysis patients.  Ann Thorac Surg. 1999;  68 1257-1261
    CrossrefPubMedSearch in Google Scholar
  • 18 Mack M J, Pfister A, Bachand D, Emery R, Magee M J, Connolly M. et al . Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease.  J Thorac Cardiovasc Surg. 2004;  127 167-173
    CrossrefPubMedSearch in Google Scholar
  • 19 Garrido P, Bobadilla J F, Albertos J, Gonzalez S J, Bastida E, Vallejo J L. et al . Cardiac surgery in patients under chronic hemodialysis.  Eur J Cardiothorac Surg. 1995;  9 36-39
    CrossrefPubMedSearch in Google Scholar
  • 20 Koyanagi T, Nishida H, Kitamura M, Endo M, Koyanagi H, Kawaguchi M. et al . Comparison of clinical outcomes of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in renal dialysis patients.  Ann Thorac Surg. 1996;  61 1793-1796
    CrossrefPubMedSearch in Google Scholar
  • 21 Tugtekin S, Kappert U, Jarny K, Knaut M, Cichon R, Alexiou K. et al . Coronary surgery in dialysis-dependent patients with end-stage renal failure with and without extracorporeal circulation.  Thorac Cardiovasc Surg. 2007;  55 84-88
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Brown J M, Poston R S, Gammie J S, Cardarelli M G, Schwartz K, Sikora J A. et al . Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes.  Ann Thorac Surg. 2006;  81 555-561
    CrossrefPubMedSearch in Google Scholar
  • 23 Dewey T M, Herbert M A, Prince S L, Robbins C L, Worley C M, Magee M J. et al . Does coronary artery bypass graft surgery improve survival among patients with end-stage renal disease?.  Ann Thorac Surg. 2006;  81 591-598
    CrossrefPubMedSearch in Google Scholar
  • 24 Nakayama Y, Sakata R, Ura M, Itoh T. Long-term results of coronary artery bypass grafting in patients with renal insuficiency.  Ann Thorac Surg. 2003;  75 500
    PubMedSearch in Google Scholar
  • 25 Jones E L, Weintraub W S. The importance of completeness of revascularization during long-term follow-up after coronary artery operations.  J Thorac Cardiovasc Surg. 1996;  112 227-237
    CrossrefPubMedSearch in Google Scholar
  • 26 Faxon D P, Ghalilli K, Jacobs A K, Ruocco N A, Christellis E M, Kellett Jr M A. et al . The degree of revascularization and outcome after multivessel coronary angioplasty.  Am Heart J. 1992;  123 854-859
    CrossrefPubMedSearch in Google Scholar
  • 27 Sergeant P, Blackstone E, Meyns B. Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important?.  J Thorac Cardiovasc Surg. 1998;  116 440-453
    CrossrefPubMedSearch in Google Scholar

Dr. Chia-Hsun Lin

Cardiovascular Surgery
Shin Kong Wu Ho-Su Memorial Hospital

No 95, Wen-Chang Road, Shih-lin 111, Taipei

Taiwan Republic of China

Email: m000678@ms.skh.org.tw