Efficacy of off-pump coronary artery bypass grafting in patients with chronic kidney disease
Masahito Minakawa, Norihiro Kondo, Kazuyuki Daitoku, Wakako Fukuda, Kaoru Hattori, Yoshiaki Saito, Anan Nomura, Takashi Ogasawara, Yasuyuki Suzuki, Kozo Fukui, Ikuo Fukuda.
Hirosaki University School of Medicine, Hirosaki, Japan.
OBJECTIVE: Complication of chronic kidney disease (CKD) is a risk factor for postoperative morbidity and mortality in coronary revascularization surgery. The purpose of this study was to assess early and long-term outcomes of off-pump coronary artery bypass grafting in patients with chronic kidney disease.
METHODS: From 2003 to 2011, 71 isolated CABG cases for the patients with chronic kidney disease (serum creatinine level >1.1mg/ml) were enrolled in this study. We compared two groups: patients who required pre-operative hemodialysis (HD Group, 19 cases) vs. non-hemodialysis (non-HD Group, 52 cases). Patients background of non-HD vs. HD groups were the following: men/ female, 37/15 vs. 17/2; age, 68.6±0.9 vs. 65.2±10.5; emergency, 13% vs. 25%; DM, 76% vs. 45%; serum creatinine, 2.0±1.2 mg/dl vs. 10.1±3.2 mg/dl; coronary lesion, 2.7±0.4 vs. 2.9±0.3; LMT lesion, 27% vs. 35%; severe atherosclerosis on the thoracic aorta, 24% vs. 25%.
RESULTS: Off-pump CABG was carried out in 88% in non-HD and 95% in HD. In non-HD group, anastomotic number was 3.2±1.2 grafted using LITA in 96%, RITA in 54%, SVG in 62% and BITA in 48%. Early graft patency of LITA, RITA and SVG were 100%, 96% and 100%, respectively. In HD group, anastomotic number was 3.1±0.8 grafted using LITA in 74%, RITA in 68%, SVG in 84% and BITA in 42%. Early graft patency of LITA, RITA and SVG were 94%, 96% and 96%, respectively. Postoperative stroke was found in 3 patients who had bilateral carotid lesion in 2 and unilateral carotid lesion in one. Mediastinitis was found in 3 patients. Hospital death was one who underwent emergency OPCAB for AMI in non-HD. 5-year survival of HD and non-HD were 90.9% vs. 88.4%, respectively (Log rank P=0.189). Freedom from MACE in 5-year of HD and non-HD were 75.4% vs. 97.6%, respectively (Log rank P=0.018).
CONCLUSIONS: Early and long-term outcome of OPCAB in patients with CKD were satisfactory.
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