Coronary artery bypass grafting in dialysis patients.
OBJECTIVE
In dialysis patients, there are two issues to consider, water-electrolyte control and a bypass technique for a calcified aorta. We used continuous hemofiltration for water-electrolyte control and an off-pump bypass with arterial grafting for a calcified aorta.


METHODS
We performed coronary artery bypass grafting with extracorporeal circulation in 9 cases and without extracorporeal circulation (off-pump bypass) in 3 cases. In 6 cases, the operation was urgent, and in 6 cases the operation was elective.


RESULTS
An average of 3.2 grafts/pt, (the arterial graft: 1.3 grafts/pt) was performed in the pump cases. In the off-pump bypass cases we used arterial grafting only (1.7 grafts/pt). We had 1 early death (sudden death) and 1 hospital death (SLE encephalopathy). One late death due to cerebral bleeding occurred at 2 years later. We used continuous hemofiltration for 2 to 11 days (average 3.9 days) in the pump cases. The off-pump cases could be controlled by conventional hemodialysis.


CONCLUSIONS
Continuous hemofiltration was very easily set up with less interference to the hemodynamics. Using an arterial graft with off-pump bypass, an aortic no-touch technique and water control with conventional hemodialysis were possible.
Tanaka
H
H
Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama, 227-8501, Japan.
Suzuki
K
K
Narisawa
T
T
Ookura
T
T
Kamio
Y
Y
Suzuki
S
S
Kitami
A
A
Suzuki
T
T
Takaba
T
T
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D006435:Renal Dialysis; D014882:Water-Electrolyte Balance