title: [Coronary artery bypass grafting in patients undergoing chronic hemodialysis: importance of wound healing and hypoproteinemia].
abstract: OBJECTIVE
  Outcome of coronary artery bypass grafting (CABG) in patients undergoing chronic hemodialysis was studied.
  
  
  METHODS
  Between January 1996 and August 2004, 49 consecutive hemodialysis patients [38 males and 11 females, mean age 60.0 years (range 47-74 years)] underwent CABG using cardiopulmonary bypass. Duration of hemodialysis was 5.2 years (range 1 month-21 years), and 32 patients were diabetics. Surgery was conducted on the emergency/urgency basis in 12 patients, and intraaortic balloon pumping was placed in 7. Left ventricular ejection fraction was 57.7 +/- 16.3% (range 27-84%). Nine patients underwent concomitant valve surgery. CABG was performed under hypothermic cardiopulmonary bypass and ventricular fibrillation except in one patient, and intraoperative hemodialysis was also performed. Continuous hemodiafiltration was used in the early period after surgery.
  
  
  RESULTS
  Number of bypass grafts was 3.0 +/- 1.0 (range 1-6), and the unilateral internal thoracic artery was used in 29 patients. Operation time, cardiopulmonary bypass time, and aorta clamp time were 313 +/- 87, 145 +/- 63, and 49 +/- 43 min, respectively. Diffuse pericardial adhesion was present in five patients. Severely atheromatous ascending aorta precluded manipulation in seven patients. Although the 30-day mortality was 2.0% (one case), all in-hospital mortality over 9 months was 14.3% (seven cases). The morbid events were mediastinitis in seven cases, reexploration for hemorrhage in seven, pneumonia in two, abdominal complication in three, and stroke in one. Delayed onset mediastinitis was common. Risk factors for death were mediastinitis and serum albumin levels < 3.5 g/dl (both p < 0.05), both of which were wound healing-related factors.
  
  
  CONCLUSIONS
  CABG in hemodialysis patients carries a high risk. Patients with hypoalbuminemia appear to require special consideration.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical School, Iruma-gun, Saitama. imanaka@saitama-med.ac.jp
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Imanaka
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Asano
authors.forename: Masanori
authors.initials: M
authors.lastname: Ogiwara
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kato
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nishimura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Katogi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yokote
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass; D003928:Diabetic Nephropathies / Q000628:therapy; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology; D007423:Intra-Aortic Balloon Pumping; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome