Long-Term Results of Open Heart Surgery in Hemodialysis Patients-CABG vs. Valve Replacement-
10.4326/jjcvs.34.9
- VernacularTitle:慢性血液透析症例における開心術後遠隔成績―ＣＡＢＧ ｖｓ．弁置換術―
- Author:
Mitsuhiro Yamamura
;
Yuji Miyamoto
;
Hideki Yao
;
Sukemasa Mukai
;
Hiroe Tanaka
;
Masaaki Ryomoto
;
Yoshiteru Yoshioka
;
Masanori Kaji
- Publication Type:Journal Article
- Keywords:
CABG
- From:Japanese Journal of Cardiovascular Surgery
2005;34(1):9-13
- CountryJapan
- Language:Japanese
-
Abstract:
We evaluated 30 patients who required hemodialysis (HD) before open heart surgery between January 1990 and September 2003. The patients were divided into 2 groups according to surgical procedure: 20 patients underwent coronary artery bypass grafting (CABG group: 14 men and 6 women, mean age, 63 years), and 10 patients underwent valve replacement (VR group: 6 men and 4 women, mean age, 56 years). The mean duration of HD in the CABG group was significantly shorter than that in the VR group (67 months: 121 months, p=0.02). The actual survival rate was calculated by Kaplan-Meier's method. No patient was lost to follow-up. There were 3 hospital deaths in the CABG group (cerebral infarction, arrhythmia, and mediastinitis), and 2 hospital deaths in the VR group (gangrenous cholecystitis and sepsis). There were also 5 late deaths in the CABG group (acute subdural hematoma, pneumonia, AMI, heart failure and gastric cancer) and 4 deaths in the VR group (uterus cancer, 2 intracerebral hemorrhages and PVE). All cardiac event deaths in the CABG group had undergone CABG only with vein grafts. The 4-year actuarial survival rates were 56% (n=5) in the CABG group with a mean follow-up period of 29 months (max 156 months), and 47% (n=3) in the VR group with a mean follow-up period of 35 months (max 131 months). There are 3 points to improve the prognosis of open heart surgery in hemodialysis patients: control of postoperative infection in both groups, prevention of cardiac events in the CABG group and careful anticoagulation therapy in the VR group.
