Early results of off-pump coronary artery bypass grafting for patients on chronic renal dialysis.
OBJECTIVE
Renal dialysis is one of the independent risk factors for coronary artery bypass graft surgery. Off-pump coronary artery bypass grafting (OPCAB) may become a good option for these patients. In this study, early results as well as surgical techniques of OPCAB in dialysis patients were analyzed compared with non-dialysis patients.


METHODS
Between July 1997 and December 2002, 471 consecutive patients who underwent OPCAB were enrolled in this study. Among them, 20 patients (4.2%) had received hemodialysis regularly for more than 3 months until the operation. Severity of coronary artery disease or clinical presentations had no significant difference, however, left ventricular function was significantly impaired in dialysis patients.


RESULTS
The average number of anastomosis was 2.8 +/- 1.0 in the dialysis group and 3.2 +/- 1.0 in the non-dialysis group (p=0.056). Twelve patients (60.0%) received 3 or more bypass grafts in the dialysis group. Among them, 6 patients were revascularized only by in-situ or composite arterial conduits using bilateral internal thoracic arteries with or without the gastroepiploic artery. No patients required aortic clamping in the dialysis group. There was no mortality or morbidity in dialysis patients. Perioperaitve bleeding and mechanical ventilation time in the intensive care unit was similar in both groups. No dialysis patients required prolonged mechanical ventilation and hemodialysis from the beginning of the operation to extubation.


CONCLUSIONS
The rationale for OPCAB for dialysis patients has been established. Total arterial revascularization without aortic clamping is applicable for dialysis patients who require multivessel bypass grafts.
Fukushima
Satsuki
S
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
Kobayashi
Junjiro
J
Tagusari
Osamu
O
Bando
Ko
K
Niwaya
Kazuo
K
Nakajima
Hiroyuki
H
Kitamura
Soichiro
S
D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012720:Severity of Illness Index; D016896:Treatment Outcome