Imanaka Kazuhito, Kyo Shunei, Asano Haruhiko, Ogiwara Masanori, Kato Masaaki, Nishimura Motonobu, Katogi Toshiyuki, Yokote Yuji, Okada Hirokazu, Suzuki Hiromichi
Department of Cardiovascular Surgery, Saitama Medical School, Iruma-gun, Saitama.
J Cardiol. 2005 Feb;45(2):47-51.
Outcome of coronary artery bypass grafting (CABG) in patients undergoing chronic hemodialysis was studied.
Between January 1996 and August 2004, 49 consecutive hemodialysis patients [38 males and 11 females, mean age 60.0 years (range 47-74 years)] underwent CABG using cardiopulmonary bypass. Duration of hemodialysis was 5.2 years (range 1 month-21 years), and 32 patients were diabetics. Surgery was conducted on the emergency/urgency basis in 12 patients, and intraaortic balloon pumping was placed in 7. Left ventricular ejection fraction was 57.7 +/- 16.3% (range 27-84%). Nine patients underwent concomitant valve surgery. CABG was performed under hypothermic cardiopulmonary bypass and ventricular fibrillation except in one patient, and intraoperative hemodialysis was also performed. Continuous hemodiafiltration was used in the early period after surgery.
Number of bypass grafts was 3.0 +/- 1.0 (range 1-6), and the unilateral internal thoracic artery was used in 29 patients. Operation time, cardiopulmonary bypass time, and aorta clamp time were 313 +/- 87, 145 +/- 63, and 49 +/- 43 min, respectively. Diffuse pericardial adhesion was present in five patients. Severely atheromatous ascending aorta precluded manipulation in seven patients. Although the 30-day mortality was 2.0% (one case), all in-hospital mortality over 9 months was 14.3% (seven cases). The morbid events were mediastinitis in seven cases, reexploration for hemorrhage in seven, pneumonia in two, abdominal complication in three, and stroke in one. Delayed onset mediastinitis was common. Risk factors for death were mediastinitis and serum albumin levels < 3.5 g/dl (both p < 0.05), both of which were wound healing-related factors.
CABG in hemodialysis patients carries a high risk. Patients with hypoalbuminemia appear to require special consideration.
研究慢性血液透析患者冠状动脉旁路移植术（CABG）的结果。
1996年1月至2004年8月期间，49例连续血液透析患者[38例男性和11例女性，平均年龄60.0岁（范围47 - 74岁）]接受了体外循环下的CABG。血液透析时间为5.2年（范围1个月至21年），32例患者为糖尿病患者。12例患者在急诊/紧急情况下进行手术，7例患者置入主动脉内球囊反搏。左心室射血分数为57.7±16.3%（范围27 - 84%）。9例患者同时进行了瓣膜手术。除1例患者外，CABG均在低温体外循环和心室颤动下进行，术中也进行了血液透析。术后早期采用连续性血液滤过透析。
搭桥血管数量为3.0±1.0（范围1 - 6），29例患者使用了单侧胸廓内动脉。手术时间、体外循环时间和主动脉阻断时间分别为313±87、145±63和49±43分钟。5例患者存在弥漫性心包粘连。7例患者因升主动脉严重粥样硬化而无法进行操作。尽管30天死亡率为2.0%（1例），但9个月内的所有住院死亡率为14.3%（7例）。不良事件包括7例纵隔炎、7例再次手术止血、2例肺炎、3例腹部并发症和1例中风。迟发性纵隔炎很常见。死亡的危险因素是纵隔炎和血清白蛋白水平<3.5 g/dl（均p<0.05），这两个因素均与伤口愈合相关。
血液透析患者的CABG风险很高。低白蛋白血症患者似乎需要特别考虑。
