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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2002 October;43(5):617-24

lingua: Inglese

Long-term results of chronic hemodialysis patients with isolated coronary artery bypass grafting performed by the same surgeon. A comparative study

Fujii H., Otani H., Okada T., Oka T., Osako M., Imamura H.

Depart­ment of Tho­racic and Car­di­o­vas­cular Sur­gery, ­Kansai Med­ical Uni­ver­sity Fumiz­o­nocho, Morig­uchi, ­Osaka, ­Japan


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Back­ground. The aim of ­this ­study was to ­examine the ­long-­term ­results of iso­lated cor­o­nary ­artery ­bypass ­grafting (­CABG) ­patients who ­required ­chronic hemo­di­al­ysis.
­Methods. ­From May 1990 to ­June 2000, 23 hemo­di­al­ysis ­patients ­received iso­lated ­CABG per­formed by the ­same sur­geon. Post­op­er­a­tive ­follow-up was com­pleted ­with max­imum dura­tion of 122 ­months.
­Results. Oper­a­tive ­deaths (n=2) ­were due to ­acute cir­cu­la­tory ­failure ­related to hemo­di­al­ysis. The ­most fre­quent ­cause of ­late ­deaths (n=10) was infec­tion. ­Five (50%) ­patients ­died of ­sepsis, and 80% of ­sepsis was ­caused by leg infec­tion asso­ciated ­with arte­rio­scle­rosis oblit­e­rans. ­There ­were 6 ­late car­diac ­events ­including 3 car­diac ­deaths. The ­actual sur­vival ­rates 1, 3, 5 and 7 ­years ­after ­CABG ­were 68.6%, 42.5%, 35.4% and 35.4%, respec­tively. And the ­actual car­diac ­event ­free ­rates 1, 3, 5 and 7 ­years ­after ­CABG ­were 77.6%, 77.6%, 46.6% and 46.6%, respec­tively. Oper­a­tive mor­tality (p=0.019), ­long-­term sur­vival (p<0.001) and car­diac ­event ­free ­rate (p=0.002) ­were sig­nif­i­cantly ­poorer in hemo­di­al­ysis ­patients ­than in non-hemo­di­al­ysis ­patients. How­ever, the ­long-­term sur­vival ­rate of our hemo­di­al­ysis ­patients ­receiving iso­lated ­CABG was ­almost sim­ilar to ­that in dial­ysis ­patients ­without ­CABG. The eti­ology of ­chronic ­renal ­failure did not sig­nif­i­cantly ­affect ­long-­term ­results. ­Using ­internal tho­racic ­artery ­graft sig­nif­i­cantly (p=0.02) ­decreased the ­late car­diac ­event in hemo­di­al­ysis ­patients, ­although it did not ­improve ­late sur­vival.
Con­clu­sions. Pri­mary ­CABG fol­lowed by aggres­sive re-inter­ven­tion ­have the ben­efit of pre­venting ­late car­diac ­death in hemo­di­al­ysis ­patients. How­ever, pre­ven­tion of ­sepsis and treat­ment of arte­rio­scle­rosis oblit­e­rans are impor­tant for ­improving the ­late sur­vival in hemo­di­al­ysis ­patients ­receiving iso­lated ­CABG.

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