Abstract
Objectives: Despite the long-term benefit, the operative results of conventional coronary artery bypass grafting for chronic hemodialysis patients remain unsatisfactory. The efficacy of off-pump coronary artery bypass grafting for hemodialysis patients is yet to be determined. The purpose of this study was to investigate the postoperative physiology of off-pump coronary artery bypass grafting for hemodialysis patients. Methods: Twenty-five hemodialysis cases who underwent isolated coronary artery bypass grafting were reviewed. Fifteen of these patients underwent off-pump coronary artery bypass grafting (off-group) and 10 underwent on-pump coronary artery bypass grafting (on-group). Comparisons were made in cardiac function (cardiac index and stroke volume index), respiratory function (AaDO2), hemodialysis management (blood urea nitrogen, creatinine, right atrial pressure, pulmonary wedge pressure), and bleeding tendency (postoperative blood loss and blood transfusion). Results: There was no operative mortality, but 3 major postoperative complications occurred (2 sternal wound infections in the off-group and 1 pneumonia in the on-group). There was no difference in cardiac index or stroke volume index. AaDO2 was significantly lower in the off-group. Plasma concentrations of blood urea nitrogen and creatinine were similar between groups. Right atrial pressure was lower and pulmonary wedge pressure tended to be lower in the off-group. Postoperative bleeding and blood transfusion were similar between groups. Conclusion: Our study confirmed that off-pump coronary artery bypass grafting is feasible for hemodialysis patients. Physiologic data showed that off-pump coronary artery bypass grafting might be effective in preserving postoperative lung oxygenation.
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References
National Institutes of Health. USRDS 2000 Annual Data Report. Bethesda, Md: National Institutes of Health; 2000. Publication No. (NIH) 00-3176: 589–684, 69–75.
Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998; 339: 799–805.
Hemmelgarn BR, Southern D, Culleton BF, Mitchell LB, Knudtson ML, Ghali WA, et al. Survival after coronary revascularization among patients with kidney disease. Circulation 2004; 110: 1890–5.
Herzog CA, Ma JZ, Collins AJ. Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation 2002; 106: 2207–11.
Agirbasli M, Weintraub WS, Chang GL, King SB, Guyton RA, Thompson TD, et al. Outcome of coronary revascularization in patients on renal dialysis. Am J Cardiol 2000; 86: 395–9.
Liu JY, Birkmeyer NJ, Sanders JH, Morton JR, Henriques HF, Lahey SJ, et al. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 2000; 102: 2973–7.
Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomized controlled trials. Lancet 2002; 359: 1194–9.
Nathoe HM, van Dijk D, Jansen EW, Suyker WJ, Diephuis JC, van Boven WJ, et al. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med 2003; 348: 394–402.
Mack MJ, Pfister A, Bachand D, Emery R, Magee MJ, Connolly M, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg 2004;127: 167–73.
Sharony R, Bizekis CS, Kanchunger M, Galloway AC, Saunders PC, Applebaum R, et al. Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: A case control study. Circulation 2003; 108 Suppl 1: II-15–II-20.
Cleveland JC Jr, Shroyer AL, Chen AV, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001; 72: 1282–9.
Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency. Ann Thorac Surg 2001; 72: 2020–5.
Tabata M, Takanashi S, Fukui T, Horai T, Uchimoro T, Kitabayashi K, et al. Off-pump coronary artery bypass grafting in patients with renal dysfunction. Ann Thorac Surg 2004; 78: 2044–9.
Osaka S, Ohsawa H, Miyazawa M, Honda J. Off-pump coronary artery bypass grafting in patients on chronic hemodialysis. J Card Surg 2001; 16: 302–9.
Hirose H, Amano A, Takahashi A. Efficacy of off-pump coronary artery bypass grafting for the patients on chronic hemodialysis. Jpn J Thorac Cardiovasc Surg 2001; 49: 693–9.
Papadimitriou LJ, Marathias KP, Alivizatos PA, Michalis A, Palatianos GM, Stavridis GT, et al. Safety and efficacy of off-pump coronary artery bypass grafting in chronic dialysis patients. Artif Organs 2003; 27: 174–80.
Tashiro T, Nakamura K, Morishige N, Iwakuma A, Tachikawa Y, Shibano R, et al. Off-pump coronary artery bypass grafting in patients with end-stage renal disease on hemodialysis. J Card Surg 2002; 17: 377–82.
Fukushima S, Kobayashi J, Tagusari O, Bando K, Niwaya K, Nakajima H, et al. Early results of off-pump coronary artery bypass grafting for patients on chronic renal dialysis. Jpn J Thorac Cardiovasc Surg 2005; 53: 186–92.
Arai H, Yoshida T, Izumi H, Sunamori M. External shunt for off-pump coronary artery bypass grafting. Distal coronary perfusion catheter. Ann Thorac Surg 2000; 70: 681–2.
Vargas FS, Terra-Filho M, Hueb W, Teixeira LR, Cukier A, Light RW. Pulmonary function after coronary artery bypass surgery. Respir Med 1997;91: 629–33.
Magnusson L, Zemgulis V., Wicky S, Tyden H, Thelin S, Hendenstierna G. Atelectasis is a major cause of hypoxemia and shunt after cardiopulmonary bypass: An experimental study. Anesthesiology 1997; 87: 1153–63.
Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 2003; 75: 853–8.
Tschernko EM, Bambazek A, Wisser W, Partik B, Jantsch U, Kubin K, et al. Intrapulmonary shunt after cardiopulmonary bypass: The use of vital capacity maneuvers versus off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2002; 124: 732–8.
Cox CM, Ascione R, Cohen AM, Davies IM, Ryder IG, Angelini GD. Effect of cardiopulmonary bypass on pulmonary gas exchange: A prospective randomized study. Ann Thorac Surg 2000; 69: 140–5.
Cimen S, Ozkul V, Ketenci B, Yurtseven N, Gunay R, Ketenci B, et al. Daily comparison of respiratory functions between on-pump and off-pump patients undergoing CABG. Eur J Cardiothoracic Surg 2003; 23: 589–94.
Roosens C, Heerman J, De Somer F, Caes F, Van Belleghem Y, Poelaert JI. Effects of off-pump coronary surgery on the mechanics of the respiratory system, lung, and chest wall: Comparison with extracorporeal circulation. Crit Care Med 2002; 30: 2430–7.
Guler M, Kirali K, Toker ME, Bozbuga N, Omeroglu SN, Akinci E, et al. Different CABG methods in patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2001; 71: 152–7.
Nakayama Y, Sakata R, Ura M. Coronary artery bypass grafting for dialysis patients. Effects of cardiopulmonary bypass. Jpn J Thorac Cardiovasc Surg 2001; 49: 504–8.
Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000; 69: 1198–204.
Selvanayagam JB, Petersen SE, Francis JM, Robson MD, Kardos A, Neubauer S, et al. Effects of off-pump versus on-pump coronary surgery on reversible and irreversible myocardial injury: A randomized trial using cardiovascular magnetic resonance imaging and biochemical markers. Circulation 2004; 109: 345–50.
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Manabe, S., Arai, H., Tanaka, H. et al. Physiological comparison of off-pump and on-pump coronary artery bypass grafting in patients on chronic hemodialysis. Jpn J Thorac Caridovasc Surg 54, 3–10 (2006). https://doi.org/10.1007/BF02743776
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DOI: https://doi.org/10.1007/BF02743776