PMID- 14655729
OWN - NLM
STAT- MEDLINE
DCOM- 20040720
LR  - 20190917
IS  - 1058-2916 (Print)
IS  - 1058-2916 (Linking)
VI  - 49
IP  - 6
DP  - 2003 Nov-Dec
TI  - Coronary bypass grafting for patients dependent on dialysis: modified 
      ultrafiltration for perioperative management.
PG  - 650-4
AB  - Coronary bypass grafting for patients on chronic dialysis has increased the risk 
      of operative mortality, and long-term survival is considered poor. Thirty-three 
      patients dependent on dialysis undergoing coronary bypass grafting were analyzed. 
      The 33 patients were divided into two groups according to the strategy for renal 
      support. In group A, 12 patients underwent continuous hemofiltration (CHF) during 
      and after cardiopulmonary bypass and CHF in an intensive care unit (ICU) and then 
      returned to regular dialysis. In group B, 21 patients underwent modified 
      ultrafiltration (UF) immediately after cardiopulmonary bypass and continuous 
      hemodialysis and filtration in an ICU with early reinstitution of regular 
      dialysis. Two patients died in group A, and there were no operative deaths in 
      group B (17% vs. 0%, p < 0.05). Three patients in group A and one patient in 
      group B had bleeding complications requiring reoperation (25% vs. 5%, p < 0.05). 
      Three patients in group A and one patient in group B needed intraaortic balloon 
      pump (IABP) support postoperatively (25% vs. 5%, p < 0.05). Four patients in 
      group A and one in group B required long-term ventilation of more than 3 days 
      (33% vs. 5%, p < 0.05). There were five patients in group A and two patients in 
      group B requiring long-term ICU stay of more than 4 days (41% vs. 10%, p < 0.05). 
      Postoperative blood loss within 24 hours was 1310 ml in group A and 623 ml in 
      group B (p < 0.05). Transfusion requirements were 9.3 units in group A and 3.0 
      units in group B (p < 0.05). During follow-up, the long-term survival, New York 
      Heart Association (NYHA) functional class, and incidence of recurrent angina were 
      considered favorable in both groups. Cardiac event-free rates after surgery at 1, 
      3, and 5 years were 88%, 73%, and 67%, respectively. The operative mortality, 
      morbidity, and long-term survival for dialysis dependent patients were reasonably 
      acceptable. As renal support, modified UF can play an important role in reducing 
      bleeding complications, shortening the ICU stay, and decreasing blood loss and 
      transfusion requirements.
FAU - Otaki, Masaki
AU  - Otaki M
AD  - Saiseikai Kyoto Hospital, Department of Cardiovascular Surgery, Kyoto, Japan.
FAU - Enmoto, Takeshi
AU  - Enmoto T
FAU - Oku, Hidetaka
AU  - Oku H
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Aged
MH  - Comorbidity
MH  - Coronary Artery Bypass/*mortality
MH  - Female
MH  - Humans
MH  - Kidney Failure, Chronic/*mortality
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/*mortality/*surgery
MH  - Perioperative Care
MH  - Postoperative Hemorrhage
MH  - Renal Dialysis/*methods
MH  - Survival Analysis
MH  - Ultrafiltration
EDAT- 2003/12/06 05:00
MHDA- 2004/07/21 05:00
CRDT- 2003/12/06 05:00
PHST- 2003/12/06 05:00 [pubmed]
PHST- 2004/07/21 05:00 [medline]
PHST- 2003/12/06 05:00 [entrez]
AID - 10.1097/01.mat.0000094632.66217.ee [doi]
PST - ppublish
SO  - ASAIO J. 2003 Nov-Dec;49(6):650-4. doi: 10.1097/01.mat.0000094632.66217.ee.