Novel adjunct to surgery for end-stage cardiomyopathy receiving hemodialysis.
Surgical management of heart failure patients receiving hemodialysis (HD) is a challenge to surgeons and reports are limited. Five patients receiving HD underwent a mitral annuloplasty with or without restoration of the left ventricle because of class III or IV heart failure due to mitral regurgitation and poor ventricular functions. Of those, three fully recovered to NYHA class I after the cardiac procedure, however, two patients remained symptomatic and required an adjunctive procedure. For that, we converted the arteriovenous dialysis shunt to an inter-arterial bypass by dividing the venous side of the shunt and anastomosing it to the proximal radial artery (RA), followed by ligation of the RA between the two anastomoses so that the RA was bypassed by the cephalic vein. Following this procedure, left ventricular end-diastolic pressure and volume were reduced, and heart failure symptoms diminished. This simple procedure was able to reduce the cardiac overload, while keeping the vascular access intact and may be a relevant adjunct to surgical reverse remodeling in end-stage heart failure patients receiving HD.
Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, Japan. ktoda2002@yahoo.co.jp
Koichi
K
Toda
Kazuhiro
K
Taniguchi
Hajime
H
Matsue
Kiyoshi
K
Yoshida
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D016121:Brachiocephalic Veins / Q000601:surgery; D006348:Cardiac Surgical Procedures; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017534:Radial Artery / Q000601:surgery; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left