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International Society For Minimally Invasive Cardiothoracic Surgery

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The Outcomes Of Off-pump Coronary Artery Bypass Grafting For Chronic Hemodialysis Patients
Shigefumi Matsuyama1, Tomohiro Imazuru2, Mitsuru Iida2, Kenji Nishimura1, Naomi Ozawa2, Masateru Uchiyama2, Hiroo Ota2, Ken Chen2, Tomoki Shimokawa2.
1Toranomon Hospital, Tokyo, Japan, 2Teikyo University Hospital, Tokyo, Japan.

BACKGROUND: The number of chronic hemodialysis (HD) patients has been increasing in Japan. And the various treatments for them are also progressing. Off-pump coronary artery bypass grafting (OPCAB) is less invasive because it does not use cardiopulmonary bypass, and it is ideal for patients with high operative risk such as HD cases. To confirm the usefulness of OPCAB for HD patients, we compared early and late outcomes between HD patients and non-HD patients. To equalize the risk factors other than HD, we used propensity score matching. METHODS: Between October 2009 and December 2017, 549 consecutive patients underwent first-time isolated OPCAB using a median approach at Teikyo University Hospital, including 69 patients on chronic hemodialysis. Propensity score matching was used, and 62 patients with HD were matched with 62 non-HD patients. RESULTS: There were no significant differences in baseline characteristics between the two groups after propensity score matching except for HD. In both groups, two cases were converted to on-pump beating CABG intraoperatively. More patients in the HD group required endarterectomy of the left anterior descending artery than in the non-HD group (p=0.0362). The 30-day mortality was 1.6% in the HD group and 0% in the non-HD group (p=0.3154). There were no significant differences in major postoperative complications between the two groups. The 8-year survival was 27.37.3% in the HD group and 59.19.7% in the non-HD group (p=0.0001). The 8-year survival free from major adverse cardiac and cerebrovascular events was 40.312% in the HD group and 60.510.3% in the non-HD group (p=0.0226). There were significant differences between the two groups. CONCLUSIONS: The early outcome of OPCAB in HD patients was the same as that in non-HD patients after propensity score matching. OPCAB may be suitable revascularization procedure for HD patients. However, the late outcome was not good.


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