Impact of concomitant cardiac procedure on coronary artery surgery in hemodialysis-dependent patients.
OBJECTIVE
Coronary artery bypass grafting (CABG) in hemodialysis-dependent patients is associated with high mortality and morbidity rates. This retrospective study was undertaken to identify the risk factors for in-hospital mortality for hemodialysis-dependent patients.


METHODS
Subjects included 87 consecutive hemodialysis-dependent patients (81 men and 6 women), aged 47-82 years (mean age, 65 years), who underwent CABG. Operative procedures included CABG alone (n=77) and CABG with valve replacement, repair, or the Dor procedure (n=10). Thirty-one perioperative risk factors were subjected to univariate and multivariate analyses to identify the risk factors for hospital death.


RESULTS
The overall in-hospital mortality rate, including operative death, was 14.9% (13/87). Univariate analysis showed the following 7 risk factors to be statistically significant predictors of hospital death: age > or = 70 years, a concomitant cardiac procedure, left ventricular ejection fraction <30%, left ventricular end-systolic volume index >70 ml/m2, a left main lesion, emergency/urgent surgery, and anemia (hemoglobin <10 mg/dl) (p<0.05 for each predictor). Multivariate logistic regression analysis confirmed that a concomitant cardiac procedure (chi-squared = 17.080, p=0.013) and age > or = 70 years (chi-squared = 9.112, p=0.019) are statistically significant independent risk factors for hospital death.


CONCLUSIONS
A concomitant cardiac procedure and age > or = 70 years were identified as significant independent risk factors for hospital mortality after CABG for hemodialysis-dependent patients. These preoperative risk factors may help in predicting operative risks and improving clinical outcomes in hemodialysis-dependent patients undergoing CABG.
Kawahito
Koji
K
Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Adachi
Hideo
H
Murata
Sei-ichiro
S
Yamaguchi
Atsushi
A
Ino
Takashi
T
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome