OFF-PUMP CORONARY ARTERY BYPASS SURGERY FOR PATIENTS WITH END-STAGE RENAL DISEASE
Takeshi Kinoshita, Tohru Asai, Tomoaki Suzuki.
Shiga University of Medical Science, Otsu, Japan.
OBJECTIVE: We clarified baseline characteristics specific for patients with end-stage renal disease (ESRD), to evaluate risk predictors of 30-day mortality, and to compare outcomes of off-pump bilateral or single ITA grafting in ESRD patients.
METHODS: Of 1,228 consecutive patients undergoing isolated CABG (1,222 by off-pump) between 2002 and 2013 at our institution, the 138 patients had ESRD (estimated glomerular filtration rate < 15 or on dialysis).
RESULTS: Patients with ESRD had significantly lower BMI (21.8 vs 23.3), and higher prevalence of diabetes (75% vs 54%), peripheral arterial disease (27% vs 17%), cerebral vascular disease (20% vs 10%), heart failure (46% vs 35%), and PCI history (41% vs 30%) than those without ESRD. No significant difference was found in age, LVEF, and number of target coronary arteries. The 30-day mortality was 8.7% (12/138). In a multivariate logistic regression model, heart failure (odds ratio, 3.56) and preoperative IABP insertion (odds ratio, 7.12) were independent risk factors of 30-day mortality. The 124 patients had two or more target vessels in the left coronary territory and received bilateral (BITA, n=77) or single (SITA, n=47) ITA with complementary SVG and/or RGEA. Although the incidence of deep sternal infection was similar between the BITA and SITA group (3.8% vs 4.3%, p=0.66), stroke tended to occur more often in the SITA group (2.6% vs 8.5%, p=0.10). The 1-, 3-, and 5-year estimated survival free from all-cause death and cardiac event respectively, in the BITA group versus the SITA group were 89% vs 81%, 83% vs 66%, and 75% vs 62% (p=0.17) and 97% vs 87%, 91% vs 74%, and 91% vs 74% (p=0.02). In multivariate Cox hazard models, independent risk factors were, for all-cause death, peripheral arterial disease (hazard ratio, 2.16), and, for cardiac event, BITA grafting (hazard ratio, 0.48) and heart failure (hazard ratio, 5.23). Propensity-score adjusted hazard ratios (95% CI) of BITA grafting were, for all-cause death, 0.82 (0.51-1.22), and, for cardiac event, 0.50 (0.33-0.87).
CONCLUSIONS: ESRD patients have multiple risk factors more often than those without ESRD. Left-sided BITA grafting has a potential to reduce cardiac event without increasing operative risk in ESRD patients.
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