COMPARATIVE STUDY
JOURNAL ARTICLE

Predictors for early and late outcomes after coronary artery bypass grafting in hemodialysis patients

Yoshiyuki Takami, Kazuyoshi Tajima, Wataru Kato, Kei Fujii, Makoto Hibino, Hisaaki Munakata, Yoshimasa Sakai
Annals of Thoracic Surgery 2012, 94 (6): 1940-5
22959572

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.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
22959572
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"