Early and Mid-term Results of Coronary Artery Bypass Grafing in the Dialysis-dependent Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHILi-qun , ZHANGJian-qun , KONGQing-yu , XIAOWei , LIANGLin , CHENXin-liang

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

CHILi-qun, Email: chiliqun2002@qq.com

Keywords：

Dialysis-dependent; End-stage renal disease; Coronary artery bypass grafting

DOI：

10.7507/1007-4848.20150116

Video：

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Objective To explore the safety and efficacy of patients with dialysis-dependent end-stage renal disease who underwent coronary artery bypass grafting (CABG). Methods We retrospectively analyzed the data of 40 dialysis-dependent patients who underwent CABG in Beijing Anzhen Hospital between January 1, 2006 and August 20, 2013. There were 27 male and 13 female patients at mean age of 63.52±9.17 years. Of them, 33 patients underwent off-pump CABG were in the off-pump CABG group, while 7 patients underwent on-pump CABG were in the on-pump CABG group. Results The average number of the grafts is 2.27±0.68. In the off-pump CABG group, 1 patient died from perioperative myocardial infarction with mortality of 3.0%.In the on-pump CABG group, the operative mortality was 28.6%, with 1 death because of serious infection and secondary multi-organ failure 15 days after the operation, and another death because of ventricular fibrillation 4 days after the operation. The follow-up rate was 100.00%. Overall mean follow-up time was 4.3±2.1 years. During the follow-up, the overall survival rate at 1 year, 3 years, and 5 years was 92.68%, 89.43%, and 82.04% respectively. Conclusion CABG can be performed in the patients with dialysis-dependent end-stage renal disease who also suffered with severe coronary artery disease, despite higher mortality. Surgeons should carefully select patients for the operation. Through optimal way of revascularization, and reasonable perioperative therapy, especially more actively use of continues renal replacement therapy, good results could be got in those kinds of patients.

Citation： CHILi-qun, ZHANGJian-qun, KONGQing-yu, XIAOWei, LIANGLin, CHENXin-liang. Early and Mid-term Results of Coronary Artery Bypass Grafing in the Dialysis-dependent Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 442-446. doi: 10.7507/1007-4848.20150116 Copy

1.	Herzog CA, Ma JZ, Collins AJ. Poor long-term survival afer acute myocardial infarction among patients on long-term dialysis. N Engl J Med, 1998, 339(12):799-805.
2.	Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol, 1998, 9(12 Suppl):S16-S 23.
3.	Williams ML, He X, Rankin JS, et al. Preoperative hematocrit is a powerful predictor of adverse outcomes in coronary artery bypass graf surgery:a report from the Society of Toracic Surgeons Adult Cardiac Surgery Database. Ann Torac Surg, 2013, 96(5):1628-163.
4.	Chou CL, Hsieh TC, Wang CH, et al. Long-term outcomes of dialysis patients after coronary revascularization:a populationbased cohort study in Taiwan. Arch Med Res, 2014, 45(2):188-194.
5.	Sezai A, Nakata K, Hata M, et al. Long-term results of dialysis patients with chronic kidney disease undergoing coronary artery bypass grafing. Ann Torac Cardiovasc Surg, 2013, 19(6):441-448.
6.	Charytan DM, Kuntz RE. Risks of coronary artery bypass surgery in dialysis-dependent patients-Analysis of the 2001 National Inpatient Sample. Nepherol Dial Transplant, 2007, 22:1665-1671.
7.	Charytan DM. How is the heart best protected in chronic dialysis patients?between Scylla and Charybdis:What is the appropriate role for percutaneous coronary revascularization and coronary artery bypass grafing in patients on dialysis? Semin Dial, 2014, 27(4):325-328.
8.	Chang TI, Leong TK, Kazi DS, et al. Comparative effectiveness of coronary artery bypass grafting and percutaneous coronary intervention for multivessel coronary disease in a community-based population with chronic kidney disease. Am Heart J, 2013, 165(5):800-808.
9.	Chang TI, Shilane D, Kazi DS, et al. Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD. J Am Soc Nephrol, 2012, 23(12):2042-2049.
10.	Wanner C, Jager KJ. Cardiovascular disease:Is CABG really better than PCI in dialysis patients? Nat Rev Nephrol, 2013, 9(4):197-198.
11.	Shroff GR, Solid CA, Herzog CA. Long-term survival and repeat coronary revascularization in dialysis patients after surgical and percutaneous coronary revascularization with drug-eluting and bare metal stents in the United States. Circulation, 2013, 127(18):1861-1869.
12.	Toumpoulis IK, Anagnostopoulos CE, DeRose JJ Jr, et al. The impact of deep sterna wound infection on long-term survival afer coronary artery bypass grafing. Chest, 2005, 127(2):464-471.
13.	Liu XR, Liu JZ, Miao Q, et al. Coronary bypass grafing in Chinese patients dependent on maintenance dialysis. Chin Med J (Engl), 2013, 126(21):4183-4185.
14.	刘沙, 王利民, 虞敏, 等.合并慢性肾功能不全患者的冠状动脉旁路移植术.中国胸心血管外科临床杂志, 2006, 13(4):272-274.
15.	胡展, 肖锋.不同肾功能评估方法对非体外循环冠状动脉旁路移植术后不良事件预测准确性的比较.中国胸心血管外科临床杂志, 2013, 20(5):518-523.
16.	Stompór T. Coronary artery calcifcation in chronic kidney disease:An update. World J Cardiol, 2014, 26, 6(4):115-129.
17.	Mohamed BA, Yang W, Litt H, Rosas SE. Valvular calcification, inflammation, and mortality in dialysis patients. J Heart Valve Dis, 2013, 22(4):584-590.
18.	Shinichi Osaka. CABG for patients on hemodialysis:comments at present. Ann Torac Cardiovasc Surg, 2010, 16(2):69-71.
19.	Ziabakhsh Tabary SH, Fazli M. Clinical outcome of coronary artery bypass grafing (CABG) in hemodialysis-dependent patients and comparison with non-renal failure patients. Eur Rev Med Pharmacol Sci, 2013, 17(19):2628-2631.
20.	Bakaeen FG, Chu D, Kelly RF, et al. Perioperative outcomes afer on-and off-pump coronary artery bypass grafing. Tex Heart Inst J, 2014, 41(2):144-151.
21.	Giuseppe B, Tiziano C, Luca B, et al. Off-pump coronary revascularization in chronic dialysis-dependent patients:early outcomes at a single institution. J Cardiovasc Med, 2010, 11(7):481-485.
22.	Beckermann J, Va Camp J, Li S, et al. On-pump versus off-pump coronary surgery outcomes in patients requiring dialysis:perspectives from a single center and the United States experience. J Torac Cardiovasc Surg, 2006, 131(6):1261-1266.
23.	Zhang L, Boyce SW, Hill PC, et al. Off-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysisdependent renal failure. Cardiovasc Revasc Med, 2009, 10(1):12-16.
24.	Vohra HA, Armstrong LA, Modi A, et al. Outcomes following cardiac surgery in patients with preoperative renal dialysis. Interact Cardiovasc Torac Surg, 2014, 18(1):103-111.
25.	Takami Y, Tajima K, Kato W, et al. Predictors for early and late outcomes after coronary artery bypass grafting in hemodialysis patients. Ann Torac Surg, 2012, 94(6):1940-1945.

1. Herzog CA, Ma JZ, Collins AJ. Poor long-term survival afer acute myocardial infarction among patients on long-term dialysis. N Engl J Med, 1998, 339(12):799-805.
2. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol, 1998, 9(12 Suppl):S16-S 23.
3. Williams ML, He X, Rankin JS, et al. Preoperative hematocrit is a powerful predictor of adverse outcomes in coronary artery bypass graf surgery:a report from the Society of Toracic Surgeons Adult Cardiac Surgery Database. Ann Torac Surg, 2013, 96(5):1628-163.
4. Chou CL, Hsieh TC, Wang CH, et al. Long-term outcomes of dialysis patients after coronary revascularization:a populationbased cohort study in Taiwan. Arch Med Res, 2014, 45(2):188-194.
5. Sezai A, Nakata K, Hata M, et al. Long-term results of dialysis patients with chronic kidney disease undergoing coronary artery bypass grafing. Ann Torac Cardiovasc Surg, 2013, 19(6):441-448.
6. Charytan DM, Kuntz RE. Risks of coronary artery bypass surgery in dialysis-dependent patients-Analysis of the 2001 National Inpatient Sample. Nepherol Dial Transplant, 2007, 22:1665-1671.
7. Charytan DM. How is the heart best protected in chronic dialysis patients?between Scylla and Charybdis:What is the appropriate role for percutaneous coronary revascularization and coronary artery bypass grafing in patients on dialysis? Semin Dial, 2014, 27(4):325-328.
8. Chang TI, Leong TK, Kazi DS, et al. Comparative effectiveness of coronary artery bypass grafting and percutaneous coronary intervention for multivessel coronary disease in a community-based population with chronic kidney disease. Am Heart J, 2013, 165(5):800-808.
9. Chang TI, Shilane D, Kazi DS, et al. Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD. J Am Soc Nephrol, 2012, 23(12):2042-2049.
10. Wanner C, Jager KJ. Cardiovascular disease:Is CABG really better than PCI in dialysis patients? Nat Rev Nephrol, 2013, 9(4):197-198.
11. Shroff GR, Solid CA, Herzog CA. Long-term survival and repeat coronary revascularization in dialysis patients after surgical and percutaneous coronary revascularization with drug-eluting and bare metal stents in the United States. Circulation, 2013, 127(18):1861-1869.
12. Toumpoulis IK, Anagnostopoulos CE, DeRose JJ Jr, et al. The impact of deep sterna wound infection on long-term survival afer coronary artery bypass grafing. Chest, 2005, 127(2):464-471.
13. Liu XR, Liu JZ, Miao Q, et al. Coronary bypass grafing in Chinese patients dependent on maintenance dialysis. Chin Med J (Engl), 2013, 126(21):4183-4185.
14. 刘沙, 王利民, 虞敏, 等.合并慢性肾功能不全患者的冠状动脉旁路移植术.中国胸心血管外科临床杂志, 2006, 13(4):272-274.
15. 胡展, 肖锋.不同肾功能评估方法对非体外循环冠状动脉旁路移植术后不良事件预测准确性的比较.中国胸心血管外科临床杂志, 2013, 20(5):518-523.
16. Stompór T. Coronary artery calcifcation in chronic kidney disease:An update. World J Cardiol, 2014, 26, 6(4):115-129.
17. Mohamed BA, Yang W, Litt H, Rosas SE. Valvular calcification, inflammation, and mortality in dialysis patients. J Heart Valve Dis, 2013, 22(4):584-590.
18. Shinichi Osaka. CABG for patients on hemodialysis:comments at present. Ann Torac Cardiovasc Surg, 2010, 16(2):69-71.
19. Ziabakhsh Tabary SH, Fazli M. Clinical outcome of coronary artery bypass grafing (CABG) in hemodialysis-dependent patients and comparison with non-renal failure patients. Eur Rev Med Pharmacol Sci, 2013, 17(19):2628-2631.
20. Bakaeen FG, Chu D, Kelly RF, et al. Perioperative outcomes afer on-and off-pump coronary artery bypass grafing. Tex Heart Inst J, 2014, 41(2):144-151.
21. Giuseppe B, Tiziano C, Luca B, et al. Off-pump coronary revascularization in chronic dialysis-dependent patients:early outcomes at a single institution. J Cardiovasc Med, 2010, 11(7):481-485.
22. Beckermann J, Va Camp J, Li S, et al. On-pump versus off-pump coronary surgery outcomes in patients requiring dialysis:perspectives from a single center and the United States experience. J Torac Cardiovasc Surg, 2006, 131(6):1261-1266.
23. Zhang L, Boyce SW, Hill PC, et al. Off-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysisdependent renal failure. Cardiovasc Revasc Med, 2009, 10(1):12-16.
24. Vohra HA, Armstrong LA, Modi A, et al. Outcomes following cardiac surgery in patients with preoperative renal dialysis. Interact Cardiovasc Torac Surg, 2014, 18(1):103-111.
25. Takami Y, Tajima K, Kato W, et al. Predictors for early and late outcomes after coronary artery bypass grafting in hemodialysis patients. Ann Torac Surg, 2012, 94(6):1940-1945.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early and Mid-term Results of Coronary Artery Bypass Grafing in the Dialysis-dependent Patients

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