Advantages of Off-Pump Coronary Artery Bypass Grafting in Long-Term Hemodialysis Patients: Multicenter Analysis

Authors

  • Junichi Nishimura
  • Haruhiko Akagi
  • Yoshiki Sawa
  • Toshiki Takahashi
  • Yuji Miyamoto
  • Kei Sakai
  • Hikaru Matsuda

DOI:

https://doi.org/10.1532/HSF98.20041061

Abstract

Objective: Long-term hemodialysis remains a major risk factor for coronary artery bypass grafting (CABG). Off-pump CABG (OPCAB) is expected to offer benefits for these high-risk patients; however, this issue has not been clarified. To elucidate the issue, we conducted a multicenter retrospective review of long-term hemodialysis patients who underwent on- or off-pump CABG.

Patients: Between January 1998 and December 2002, 53 hemodialysis patients underwent elective CABG at 14 centers. Nineteen patients underwent OPCAB, and 34 patients underwent conventional CABG (CCAB). Preoperative and perioperative variables, morbidity, and mortality were compared in the 2 groups. There were no significant differences in preoperative variables between the 2 groups.

Results: The length of intensive care unit (ICU) stay (3.7 versus 5.9 days), the amount of blood loss (668 versus 1100 mL), and the amount of red cell transfusion (4.7 versus 12.2 units) were less in the OPCAB group. The perioperative morbidity was significantly lower in the OPCAB group (0.0% versus 26.5%). The hospital mortality was not significant but was low in the OPCAB group (0% versus 14.7%, P = .079).

Conclusion: OPCAB significantly decreased blood loss, blood transfusion, ICU stay, and major perioperative morbidity compared with the values for CCAB. OPCAB may have advantages over CCAB in long-term hemodialysis patients.

References

Abu-Omar Y, Taggart DP. 2002. Off-pump coronary artery bypass grafting. Lancet 360:327-30.nAgirbasli M, Weintraub WS, Chang GL, et al. 2000. Outcome of coronary revascularization in patients on renal dialysis. Am J Cardiol 86:395-9.nAngelini GD, Taylor FC, Reeves BC, Ascione R. 2002. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359:1194-9.nBhattacharyya N, Cheung AH, Dang CR, et al. 1997. Open heart surgery in patients with end-stage renal disease. Am J Nephrol 17:435-9.nDacey LJ, Liu JY, Braxton JH, et al. 2002. Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 74:458-62.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 70:813-8.nGelsomino S, Morocutti G, Masullo G, et al. 2001. Open heart surgery in patients with dialysis-dependent renal insufficiency. J Card Surg 16:400-7.nKaul TK, Fields BL, Reddy MA, Kahn DR. 1994. Cardiac operations in patients with end-stage renal disease. Ann Thorac Surg 57:691-6.nKo W, Kreiger KH, Isom OW. 1993. Cardiopulmonary bypass procedures in dialysis patients. Ann Thorac Surg 55:677-84.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.nMenzoian JO, Davis RC, Idelson BA, Mannick JA, Berger RL. 1974. Coronary artery by-pass surgery and renal transplantation: a case report. Ann Surg 179:63-4.nNational Institutes of Health. 2000. USRDS 2000 Annual Data Report. Rockville, Md: National Institutes of Health. Publication (NIH) 00-3176 589-684,69-75.nReston JT, Tregear SJ, Turkelson CM. 2003. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg 76:1510-5.nSamuels LE, Sharma S, Morris RJ, et al. 1996. Coronary artery bypass grafting in patients with chronic renal failure: a reappraisal. J Card Surg 11:128-33.nvan Dijk D, Nierich AP, Jansen EW, et al. 2001. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation 104:1761-6.n

Published

2005-01-04

How to Cite

Nishimura, J., Akagi, H., Sawa, Y., Takahashi, T., Miyamoto, Y., Sakai, K., & Matsuda, H. (2005). Advantages of Off-Pump Coronary Artery Bypass Grafting in Long-Term Hemodialysis Patients: Multicenter Analysis. The Heart Surgery Forum, 7(5), E370-E373. https://doi.org/10.1532/HSF98.20041061

Issue

Section

Articles

Most read articles by the same author(s)