Predictors for Early and Late Outcomes After Coronary Artery Bypass Grafting in Hemodialysis Patients

Takami, Yoshiyuki; Tajima, Kazuyoshi; Kato, Wataru; Fujii, Kei; Hibino, Makoto; Munakata, Hisaaki; Sakai, Yoshimasa

doi:10.1016/j.athoracsur.2012.07.037

Cited by 34 publications

(34 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A large observational retrospective study demonstrated the superiority of CABG over percutaneous coronary interventions in dialysis patients attributable to the utilization of ITA grafts (2). A smaller observational study on CABG in dialysis patients showed that the use of arterial coronary bypass (which was left ITA in 95% of patients) was associated with a decreased occurrence of major cardiovascular events, in comparison to the use of a saphenous venous graft (15).…”

Section: Discussionmentioning

confidence: 99%

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

et al. 2017

View full text Add to dashboard Cite

Background The possibility of coronary steal through an arteriovenous fistula (AVF) in hemodialysis (HD) patients with coronary artery bypass grafts (CABGs) using an ipsilateral internal thoracic artery (ITA) has been suggested. In order to define the significance of such a possibility, we analyzed cardiac events and mortality risk in patients in relation to AVF flow. Methods A retrospective cohort study was performed on prevalent HD patients from a single center. The outcomes included a first cardiac event, cardiac death and death from any cause. Results The group consisted of 23 chronic HD patients having ITA CABG and upper extremity AV access, 12 patients had an ipsilateral and 11 patients had a contralateral location of ITA CABG and an upper extremity AV access. The mean follow-up period was for 37.0 months. Multivariable Cox proportional-hazards regression analysis of risk of death from any cause in relation to AV access flow showed no increased risk, neither in the group with ipsilateral location of ITA grafts and dialysis accesses (adjusted HR, 3.047 [95% CI, 0.996 to 1.000], p = 0.081), nor in the group with contralateral location of both shunts (adjusted HR, 0.173 [95% CI, 0.997 to 1.002], p = 0.678). There was no significant correlation between AV access blood flow and the risk of first cardiac event as well as cardiac death in either study group. Conclusions In this study on HD patients having ipsilateral ITA CABG and AVF, fistula flow rate was not found to be associated with mortality or cardiac risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Recent literature has shown the need for dialysis to be an independent predictor of mortality with a twofold‐ to threefold‐increased hospital mortality following CABG in patients with preoperative dialysis dependence . Although dialysis has been shown to heighten risk as a stand‐alone predictor of mortality, the analysis of CABG outcomes for dialysis patients is complicated by the large burden of comorbid conditions that influence patient survival in the dialysis population .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal outcomes of dialysis‐dependent patients undergoing isolated coronary artery bypass grafting

et al. 2019

View full text Add to dashboard Cite

Background Dialysis‐dependent patients have a higher risk of short‐term morbidity and mortality following cardiac surgery. However, longitudinal survival and readmissions in this patient population after isolated coronary artery bypass grafting (CABG) are lacking in the literature. Methods All patients undergoing isolated CABG from 2011 to 2017 were included. Perioperative data were retrospectively extracted from a prospectively maintained cardiac surgical database with a primary focus on longitudinal mortality and readmissions. Results The total study population consisted of 6874 nondialysis‐dependent patients and 174 patients with dialysis dependence. Patients in the dialysis‐dependent group presented a higher risk of morbidity and mortality as reflected in the Society of Thoracic Surgeons‐Predicted Risk of Morbidity and Mortality (STS‐PROM) (8.4% ± 9.7% vs 2.3% ± 3.9%; P < 0.001). Operative (30‐day) mortality was significantly higher in the dialysis group (8.6% vs 2.3%; P < 0.001). Unadjusted outcomes yielded 30‐day (92% vs 98%; P < 0.001), 1‐year (80% vs 94%; P < 0.001), and 5‐year (38% vs 84%; P < 0.001) survival that was significantly worse for the dialysis group. Freedom from readmission at 30 days (93% vs 87%; P = 0.005), 1 year (78% vs 56%; P < 0.001), and 5 years (62% vs 39%; P < 0.001) was significantly better for the nondialysis cohort. Dialysis dependence was an independent predictor of mortality at 30 days (hazard ratio [HR], 3.86; 95% confidence interval [CI], 2.96, 5.03; P < 0.001), 1 year (HR, 3.20; 95% CI, 2.14, 2.79; P < 0.001), and 5 years (HR, 4.02; 95% CI, 3.07, 5.26; P < 0.001) despite risk adjustment. Conclusion Dialysis‐dependent patients have significantly elevated operative risk, which translates to worse short‐ and long‐term survival following isolated CABG. The need for dialysis alone is an independent predictor of both mortality and readmission in the midterm.

show abstract

“…[1][2][3][4][5][6][7][8][9][10][11] In addition, many patients develop major cardiac and cerebrovascular events or infections after discharge and the long-term results are not satisfactory. Yeo et al reported that the operative mortality of coronary artery bypass grafting (CABG) increased significantly with each stage of chronic kidney disease (CKD), and patients in stage 5 (estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m 2 or dialysis) had a far higher operative mortality than patients in stage 4 or lower.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

Sezai

Osaka

Yaoita

et al. 2016

ATCS

View full text Add to dashboard Cite

Purpose: Recently, performance of cardiac surgery in hemodialysis patients has increased, but the mortality rate is high. Methods: We retrospectively examined the early and long-term outcomes in 128 dialysis patients who underwent cardiac surgery with or without carperitide infusion and were followed for 2 years. Sixty-three patients received carperitide infusion during surgery and 65 patients did not. Results: The hospital mortality rate was 1.6% in the carperitide group and 12.3% in the non-carperitide group, being significantly lower in the carperitide group. The 2-year actuarial survival rate was 90.5% ± 3.7% in the carperitide group, and 76.9% ± 5.2% in the non-carperitide group, while the major adverse cardiovascular and cerebrovascular events (MACCE)-free rate at 2 years postoperatively was 90.5% ± 3.7% in the carperitide group and 67.7% ± 5.8% in the non-carperitide group. Conclusions: These findings suggest that carperitide improves the early postoperative outcome in dialysis patients undergoing cardiac surgery, as has already been demonstrated in non-dialysis patients. An early postoperative cardioprotective effect of carperitide and improvement of renal function in oliguric patients might have contributed to this outcome. However, this was a retrospective study, so a prospective investigation is required to demonstrate the mechanisms involved. In addition, further evaluation of the long-term results would be desirable.

show abstract

Predictors for Early and Late Outcomes After Coronary Artery Bypass Grafting in Hemodialysis Patients

Cited by 34 publications

References 21 publications

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

Longitudinal outcomes of dialysis‐dependent patients undergoing isolated coronary artery bypass grafting

Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

Contact Info

Product

Resources

About