title: Coronary artery bypass grafting in hemodialysis-dependent patients: analysis of Japan Adult Cardiovascular Surgery Database.
abstract: BACKGROUND
  Perioperative risk during coronary artery bypass grafting (CABG) is reportedly high in patients with chronic renal disease. We aimed to determine postoperative mortality and morbidity and identify the perioperative risk factors of mortality during CABG in hemodialysis (HD)-dependent patients.
  
  
  RESULTS
  From the Japan Adult Cardiovascular Surgery Database, we compared 1,300 HD-dependent chronic renal failure patients with 18,387 non-HD patients who all underwent isolated CABG between January 2005 and December 2008. The operative mortality and mortality, including major morbidity, was 4.8% vs. 1.4% and 23.1% vs. 13.7% in the HD and non-HD groups, respectively. Preoperative predictors of operative mortality included age, chronic obstructive pulmonary disease, peripheral arterial disease, congestive heart failure, arrhythmia, preoperative inotropic agent requirement, New York Heart Association class IV, urgent or emergency operation, poor left ventricular function, aortic valve regurgitation (>2), and mitral valve regurgitation (>3). Postoperative predictors of operative mortality included stroke, infection, prolonged ventilation, pneumonia, heart block, and gastrointestinal complications.
  
  
  CONCLUSIONS
  Compared with non-HD patients, CABG in HD patients was associated with high mortality and morbidity rates. An appropriate surgical strategy and careful perioperative assessment and management for prevention of respiratory and gastrointestinal complications might contribute to improved clinical outcomes after CABG in these patients.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita 565-0871, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsukihara
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate