Coronary bypass grafting for patients dependent on dialysis: modified ultrafiltration for perioperative management.
Coronary bypass grafting for patients on chronic dialysis has increased the risk of operative mortality, and long-term survival is considered poor. Thirty-three patients dependent on dialysis undergoing coronary bypass grafting were analyzed. The 33 patients were divided into two groups according to the strategy for renal support. In group A, 12 patients underwent continuous hemofiltration (CHF) during and after cardiopulmonary bypass and CHF in an intensive care unit (ICU) and then returned to regular dialysis. In group B, 21 patients underwent modified ultrafiltration (UF) immediately after cardiopulmonary bypass and continuous hemodialysis and filtration in an ICU with early reinstitution of regular dialysis. Two patients died in group A, and there were no operative deaths in group B (17% vs. 0%, p < 0.05). Three patients in group A and one patient in group B had bleeding complications requiring reoperation (25% vs. 5%, p < 0.05). Three patients in group A and one patient in group B needed intraaortic balloon pump (IABP) support postoperatively (25% vs. 5%, p < 0.05). Four patients in group A and one in group B required long-term ventilation of more than 3 days (33% vs. 5%, p < 0.05). There were five patients in group A and two patients in group B requiring long-term ICU stay of more than 4 days (41% vs. 10%, p < 0.05). Postoperative blood loss within 24 hours was 1310 ml in group A and 623 ml in group B (p < 0.05). Transfusion requirements were 9.3 units in group A and 3.0 units in group B (p < 0.05). During follow-up, the long-term survival, New York Heart Association (NYHA) functional class, and incidence of recurrent angina were considered favorable in both groups. Cardiac event-free rates after surgery at 1, 3, and 5 years were 88%, 73%, and 67%, respectively. The operative mortality, morbidity, and long-term survival for dialysis dependent patients were reasonably acceptable. As renal support, modified UF can play an important role in reducing bleeding complications, shortening the ICU stay, and decreasing blood loss and transfusion requirements.
Otaki
Masaki
M
Saiseikai Kyoto Hospital, Department of Cardiovascular Surgery, Kyoto, Japan.
Enmoto
Takeshi
T
Oku
Hidetaka
H
D000368:Aged; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000601:surgery*; D019990:Perioperative Care; D019106:Postoperative Hemorrhage; D006435:Renal Dialysis / Q000379:methods*; D016019:Survival Analysis; D014462:Ultrafiltration