Does Off-Pump Bilateral Internal Thoracic Artery Grafting Increase Operative Risk in Dialysis Patients?

  • Takeshi Kinoshita
  • Tohru Asai
  • Soh Hosoba
  • Noriyuki Takashima
  • Osamu Nishimura
  • Norihiko Hiramatsu
  • Tomoaki Suzuki
  • Atsushi Kambara
  • Keiji Matsubayashi

Abstract

Background: We compared short-term outcomes of patients with chronic dialysis receiving bilateral internal thoracic artery (BITA) grafting with single internal thoracic artery (SITA) grafting using propensity score analysis.

Methods: Between 2002 and 2008, 656 consecutive patients underwent isolated coronary artery bypass grafting (99.1% off-pump). Of these, 56 patients with chronic dialysis and multivessel disease were retrospectively compared according to surgical technique, BITA (n = 32) or SITA (n = 23) grafting. In an attempt to minimize the selection bias, propensity scores were created based on 13 preoperative factors (C statistics, 0.914).

Results: There was no significant difference in age, left ventricular ejection fraction, prevalence of diabetes mellitus, and logistic euroSCORE between the 2 groups. All patients underwent revascularization using the off-pump technique without conversion to cardiopulmonary bypass. All arterial conduits were harvested using skeletonization technique. Except for 1 patient, all ITAs were used as in situ graft. Complete revascularization was achieved in all patients. There was no significant difference in occurrence of mediastinitis, impaired wound healing, and stroke between the 2 groups. The 30-day mortality was 6.3% in the BITA group and 13.0% in the SITA group (P = .64). After adjusting for propensity score, BITA grafting was not associated with impaired wound healing (odds ratio, 0.63; 95% confidence interval, 0.04 to 8.79; P = .73) and 30-day mortality (odds ratio, 0.60; 95% confidence interval, 0.05 to 6.82; P = .68).

Conclusion: In situ skeletonized BITA grafting is safe and feasible in dialysis patients with multivessel disease.

References

Asai T, Tabata S. 2002. Skeletonization of the right gastroepiploic artery using an ultrasonic scalpel. Ann Thorac Surg 74:1715-7.\nAsai T. 2006. Technique and results for skeletonized GEA using the Harmonic Scalpel in combination with other arterial grafts in off-pump coronary artery bypass surgery. Arterial Grafting for Coronary Artery Bypass Surgery, 2nd Edition, New York, NY: Springer-Verlag; 196-200.\nCaputo M, Reeves BC, Rajkaruna C, Awair H, Angelini GD. 2005. Incomplete revascularization during OPCAB surgery is associated with reduced mid-term event-free survival. Ann Thorac Surg 80:2141-7.\nDacey LJ, Liu JY, Braxton JH, et al. 2002. Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 74:458-63.\nDe Paulis R, de Notaris S, Scaffa R, et al. 2005. The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: the role of skeletonization. J Thorac Cardiovasc Surg 129:536-43.\nFranga DL, Kratz JM, Crumbley AJ, Zellner JL, Stroud MR, Crawford FA. 2000. Early and long-term results of coronary artery bypass grafting in dialysis patients. Ann Thorac Surg 70:813-9.\nHannan EL, Wu C, Smith CR, et al. 2007. Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation 116:1145-52.\nHigami T, Kozawa S, Asada T, Shida T, Ogawa K. 2000. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg 70:307-8.\nHigami T, Yamashita T, Nohara H, Iwahashi K, Shiga T, Ogawa K. 2001. Early results of coronary grafting using ultrasonically skeletonized internal thoracic arteries. Ann Thorac Surg 71:1224-8.\nHirose H, Amano A, Takahashi A. 2001. Efficacy of off-pump coronary artery bypass grafting for the patients on chronic hemodialysis. Jpn J Thorac Cardiovasc Surg 49:693-9.\nKai M, Okabayashi H, Hanyu M, et al. 2007. Long-term results of bilateral internal thoracic artery grafting in dialysis patients. Ann Thorac Surg 83:1666-71.\nKhaitan L, Sutter FP, Goldman SM. 2000. Coronary artery bypass grafting in patients who require long-term dialysis. Ann Thorac Surg 69:1135-9.\nKleisli T, Cheng W, Jacobs MJ, et al. 2005. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg 129:1283-91.\nLégaré JF, Buth KJ, Sullivan JA, Hirsch GM. 2004. Composite arterial grafts versus conventional grafting for coronary artery bypass grafting. J Thorac Cardiovasc Surg 127:160-6.\nNakano J, Okabayashi H, Hanyu M, et al. 2008. Risk factors for wound infection after off-pump coronary artery bypass grafting: should bilateral internal thoracic arteries be harvested in patients with diabetes? J Thorac Cardiovasc Surg 135:540-5.\nNakayama Y, Sakata R, Ura M. 2001. Bilateral internal thoracic artery use for dialysis patients: does it increase operative risk? Ann Thorac Surg 71:783-7.\nLabrousse L, de Vincentiis C, Madonna F, Deville C, Roques X, Baudet E. 1999. Early and long term results of coronary artery bypass grafts in patients with dialysis dependent renal failure. Eur J Cardiothorac Surg 15:691-6.\nLiu JY, Birkmeyer NJ, Sanders JH, et al. 2000. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery: Northern New England Cardiovascular Disease Study Group. Circulation 102:2973-7.\nPapadimitriou LJ, Marathias KP, Alivizatos PA, et al. 2003. Safety and efficacy of off-pump coronary artery bypass grafting in chronic dialysis patients. Artif Organs 27:174-80.\nPeterson MD, Borger MA, Rao V, Peniston CM, Feindel CM. 2003. Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. J Thorac Cardiovasc Surg 126:1314-9.\nPuskas JD, Cheng D, Knight J, et al. 2005. Off-pump versus conventional coronary artery bypass grafting: a meta-analysis and consensus statement from the 2004 ISMICS consensus conference. Innovations 1:3-27.\nPuskas JD, Williams WH, Mahoney EM, et al. 2004. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA 291:1841-9.\nTashiro T, Nakamura K, Morishige N, et al. 2002. Off-pump coronary artery bypass grafting in patients with end-stage renal disease on hemodialysis. J Card Surg 17:377-82.\nWilliams ML, Muhlbaier LH, Schroder JN, et al. 2005. Risk-adjusted short- and long-term outcomes for on-pump versus off-pump coronary artery bypass surgery. Circulation 112:I366-70.\n
Published
2010-05-05
How to Cite
Kinoshita, T., Asai, T., Hosoba, S., Takashima, N., Nishimura, O., Hiramatsu, N., Suzuki, T., Kambara, A., & Matsubayashi, K. (2010). Does Off-Pump Bilateral Internal Thoracic Artery Grafting Increase Operative Risk in Dialysis Patients?. The Heart Surgery Forum, 13(2), E74-E79. https://doi.org/10.1532/HSF98.2009-1159
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Articles