[Open heart surgery in three patients receiving dialysis for more than 20 years].
In Japan, the number of chronic hemodialysis (HD) patients is increasing, and there are 7,000 cases with a more than 20 year history of HD. At our institute, we have experienced 135 cases of open heart surgery in patients on HD, including 92 isolated CABG cases and 43 other open heart surgery cases. However, open heart surgery for patients with a more than 20 year history on HD is rare. Open heart surgery on HD patients is rather difficult, since perioperative management can be complicated and special care must be taken for prophylaxis of infection, fluid and electrolyte management and anticoagulation therapy. Many complications have been published in HD patients. At our institute, 3 cases of open heart surgery in patients with more than a 20 year history of HD have been performed. These included triple CABG, double CABG + AVR and double CABG in a post-kidney transplantation patient. They were discharged uneventfully with angiographically patent grafts. It is concluded that for CABG in patients on HD, aggressive use of arterial conduits for revascularization is recommended. For patients with a transplanted kidney, careful management against dysfunction and rejection is necessary.
Ishida
T
T
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan.
Nishida
H
H
Tomizawa
Y
Y
Noji
S
S
Uwabe
K
K
Tomioka
H
H
Morishita
A
A
Endo
M
M
Koyanagi
H
H
D000789:Angina, Unstable / Q000150:complications / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery; D001424:Bacterial Infections / Q000517:prevention & control; D001026:Coronary Artery Bypass; D005260:Female; D005440:Fluid Therapy; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D006435:Renal Dialysis; D013997:Time Factors
D000925:Anticoagulants