| Long-Term Results of Open Heart
Surgery in Hemodialysis Patients―CABG vs. Valve Replacement― |
(Department of Cardiovascular Surgery, Hyogo College
of Medicine, Nishinomiya, Japan)
| Mitsuhiro Yamamura |
Yuji Miyamoto |
Hideki Yao |
| Sukemasa Mukai |
Hiroe Tanaka |
Masaaki Ryomoto |
| Yoshiteru Yoshioka |
Masanori Kaji |
|
|
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.
Jpn. J. Cardiovasc. Surg. 34: 9-13 (2005) |
|
