title: On-pump beating-heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients.
abstract: BACKGROUND
  On-pump beating-heart coronary artery bypass grafting surgery (CABG) is beneficial due to the elimination of cardioplegic arrest. However, there are few reports regarding its efficacy in chronic hemodialysis patients. This study investigated the potential benefits of on-pump beating-heart CABG in chronic hemodialysis patients.
  
  
  METHODS
  From January 2002 to January 2010, 186 patients with chronic hemodialysis underwent CABG in our institution. In total, 82 patients underwent conventional CABG with cardioplegic arrest, 56 underwent off-pump CABG and 48 underwent on-pump beating-heart CABG. The early results and long-term outcomes were compared among these three groups.
  
  
  RESULTS
  On-pump beating-heart CABG significantly reduced the duration of cardiopulmonary bypass (CPB) compared with conventional CABG. The post-operative pericardial drainage amount (P < 0.01), length of hospital stay (P < 0.001) and length of post-operative intensive care unit stay (P < 0.001) were significantly lower in the on-pump beating-heart and off-pump CABG groups than in the conventional CABG group. No significant difference was found regarding 30-day mortality and morbidity rates including stroke, pneumonia, arrhythmia, intestinal complication and low cardiac output syndrome. There were no statistical differences in the freedom from cardiac events (P = 0.323), but on-pump beating-heart CABG provided better long-term survival than conventional CABG (P = 0.009).
  
  
  CONCLUSIONS
  On-pump beating-heart CABG is a safe procedure that provides optimal operative exposure in chronic hemodialysis patients. The use of CPB and the elimination of cardioplegic arrest may be beneficial for the short- and long-term survival of chronic hemodialysis patients.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Tsai
authors.forename: Feng-Yen
authors.initials: FY
authors.lastname: Lin
authors.forename: Ching-Huang
authors.initials: CH
authors.lastname: Lai
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Lin
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Lin
authors.forename: Chien-Sung
authors.initials: CS
authors.lastname: Tsai
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000502:physiology; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome