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)

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.

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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