title: Predictors for early and late outcomes after coronary artery bypass grafting in hemodialysis patients.
abstract: BACKGROUND
  Markedly higher hospital and long-term mortality after coronary artery bypass grafting (CABG) have been reported in hemodialysis (HD)-dependent patients. We tried to identify the predictors for short-term and long-term outcomes after CABG, which have not been well studied.
  
  
  METHODS
  Between 1993 and 2010, 152 patients undergoing HD (117 men; HD duration of 8.7±8.0 years) underwent isolated CABG. Our strategies included use of a single internal thoracic artery (ITA) in patients with diabetes mellitus (DM), bilateral ITAs in patients without DM, and possible avoidance of cardiopulmonary bypass (CPB) after 2003.
  
  
  RESULTS
  Thirty-six percent of patients underwent conventional CABG: 20% had on-pump beating heart procedures and 44% had off-pump procedures, with 2.8±1.0 anastomoses. Hospital mortality was 10.6% with improvement to 6.8% after 2003. Predictors for hospital death were left ventricular ejection fraction (LVEF) less than 0.40 (p=0.042), use of CPB (p=0.046), and postoperative need for continuous hemofiltration (p=0.037). After follow-up of 49±42 months, the overall survival rates were 76.9%, 60.0%, 43.9%, and 36.2% and the cardiac events-free rates were 77.0%, 70.1%, 55.9%, and 44.8% at 3, 5, 8, and 10 years, respectively, in the Kaplan-Meier model. A multivariate Cox proportional hazard model identified age older than 63 years (p=0.014), DM (p=0.036), and peripheral artery disease (PAD) (p=0.044) as predictors for late death, and DM (p=0.038) and LVEF less than 0.40 (p=0.027) as predictors for late cardiac events.
  
  
  CONCLUSIONS
  Although early outcomes have been improved by off-pump techniques, late outcomes are not satisfactory in patients who rely on HD and undergo CABG. To improve late outcomes we may need aggressive management of DM, PAD, and low LVEF in those patients.
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. takami@nagoya2.jrc.or.jp
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takami
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.forename: Wataru
authors.initials: W
authors.lastname: Kato
authors.forename: Kei
authors.initials: K
authors.lastname: Fujii
authors.forename: Makoto
authors.initials: M
authors.lastname: Hibino
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Munakata
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors