ObjectiveCoronary artery bypass grafting is currently the best treatment for dialysis
patients with multivessel coronary artery involvement. Vasoplegic syndrome
of inflammatory etiology constitutes an important postoperative
complication, with highly negative impact on prognosis. Considering that
these patients have an intrinsic inflammatory response exacerbation, our
goal was to evaluate the incidence and mortality of vasoplegic syndrome
after myocardial revascularization in this group.MethodsA retrospective, single-center study of 50 consecutive and non-selected
dialysis patients who underwent myocardial revascularization in a tertiary
university hospital, from 2007 to 2012. The patients were divided into 2
groups, according to the use of cardiopulmonary bypass or not (off-pump
coronary artery bypass). The incidence and mortality of vasoplegic syndrome
were analyzed. The subgroup of vasoplegic patients was studied
separately.ResultsThere were no preoperative demographic differences between the
cardiopulmonary bypass (n=20) and off-pump coronary artery bypass (n=30)
group. Intraoperative data showed a greater number of distal coronary
arteries anastomosis (2.8 vs. 1.8,
P<0.0001) and higher transfusion rates (65%
vs. 23%, P=0.008) in the
cardiopulmonary bypass group. Vasoplegia incidence was statistically higher
(P=0.0124) in the cardiopulmonary bypass group (30%)
compared to the off-pump coronary artery bypass group (3%). Vasoplegia
mortality was 50% in the cardiopulmonary bypass group and 0% in the off-pump
coronary artery bypass group. The vasoplegic subgroup analysis showed no
statistically significant clinical differences.ConclusionCardiopulmonary bypass increased the risk for developing postoperative
vasoplegic syndrome after coronary artery bypass grafting in patients with
dialysis-dependent chronic renal failure.
Background Coronary artery bypass grafting currently is the best treatment for dialytic
patients with multivessel coronary disease, but hospital morbidity and mortality
related to procedure is still high. ObjectiveEvaluate results and in-hospital outcomes of coronary artery bypass grafting in
dialytic patients. Methods Retrospective unicentric study including 50 consecutive and not selected dialytic
patients, who underwent coronary artery bypass grafting in a tertiary university
hospital from 2007 to 2012. Results High prevalence of cardiovascular risk factors was observed (100% hypertensive,
68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of
the procedures were performed off-pump. There were seven (14%) in-hospital deaths.
Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal
ventricular function and surgical re-exploration were associated with increased
mortality. ConclusionCoronary artery bypass grafting is feasible to dialytic patients although high
in-hospital morbidity and mortality. It is necessary better understanding about
metabolic aspects to plan adequate interventions.
BackgroundMyocardial revascularization surgery is the best treatment for dyalitic
patients with multivessel coronary disease. However, the procedure still has
high morbidity and mortality. The use of extracorporeal circulation (ECC)
can have a negative impact on the in-hospital outcomes of these
patients.ObjectivesTo evaluate the differences between the techniques with ECC and without ECC
during the in-hospital course of dialytic patients who underwent surgical
myocardial revascularization.MethodsUnicentric study on 102 consecutive, unselected dialytic patients, who
underwent myocardial revascularization surgery in a tertiary university
hospital from 2007 to 2014.ResultsSixty-three patients underwent surgery with ECC and 39 without ECC. A high
prevalence of cardiovascular risk factors was found in both groups, without
statistically significant difference between them. The group "without ECC"
had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and
increased need for blood components (77.7% vs. 25.6%; p <0.0001) and
inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative
course, the group "without ECC" required less vasoactive drugs, (61.5% vs.
82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours
vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating
room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p
= 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as
compared with the group with ECC surgery. No difference in mortality was
found between the groups.ConclusionMyocardial revascularization with ECC in patients on dialysis resulted in
higher morbidity in the perioperative period in comparison with the
procedure without ECC, with no difference in mortality though.
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