Advantages of off-pump coronary artery bypass grafting in long-term hemodialysis patients: multicenter analysis.
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.


METHODS
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).


CONCLUSIONS
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.
Nishimura
Junichi
J
Department of Cardiovascular Surgery, Yao Tokushukai General Hospital, Japan.
Akagi
Haruhiko
H
Sawa
Yoshiki
Y
Takahashi
Toshiki
T
Miyamoto
Yuji
Y
Sakai
Kei
K
Matsuda
Hikaru
H
D001803:Blood Transfusion / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000401:mortality*; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome