| Hemodiafiltration during Off-Pump Coronary
Artery Bypass Grafting for a Chronic Dialysis Patient |
(Department of Cardiovascular and
Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural
University of Medicine, Kyoto, Japan)
| Atsushi Fukumoto |
Hitoshi Yaku |
Kiyoshi Doi |
| Satoshi Numata |
Kyoko Hayashida |
Mitsugu Ogawa |
| Tomoya Inoue |
Nobuo Kitamura |
|
|
Patients on chronic hemodialysis,
undergoing coronary artery bypass grafting (CABG) have high
perioperative mortality and morbidity. In order to reduce the
perioperative risks, we performed intraoperative hemodiafiltration
(HDF) during off-pump CABG (OPCAB). A 62 year-old-man, who had
been on dialysis for 2 years, was admitted with a sensation of
chest compression. A coronary angiography revealed 75% stenosis
with severe calcification in the left anterior descending artery
and 90% stenosis in the second diagonal branch. During the
operation, veno-venous HDF was started, using a double lumen
catheter that was introduced into the femoral vein at the same
time that a skin incision was made. During the exposure of the
diagonal branch by rotating the heart, the blood flow of HDF was
decreased and dehydration was halted to avoid hemodynamic
deterioration. The patient was extubated 1.5 h after the operation
and did not require continuous hemodiafiltration (CHDF) in the
intensive care unit (ICU). Routine hemodialysis was restarted
on the 3rd postoperative day. The postoperative course was
uneventful, and the patient was discharged to home on the 11th
postoperative day. HDF during OPCAB for this chronic dialysis
patient was observed to be effective and yielded an excellent
postoperative recovery without CHDF in the ICU.
Jpn. J. Cardiovasc. Surg. 34: 216-219 (2005) |
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