A De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2010 Jul;11(7):481-7. doi: 10.2459/jcm.0b013e328335730a.
Atherosclerotic vascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Several authors reported that chronic dialytic patients have a high operative risk when submitted to coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) whereas little information exists about off-pump myocardial revascularization in these patients.
Between January 2000 and December 2008, 17 consecutive patients (12 men, mean age of 62.3 +/- 12.3 years) with end-stage renal failure maintained on chronic hemodialysis underwent isolated off-pump CABG at our center. To evaluate this approach we compared the outcomes of off-pump revascularization with those obtained in the same period in 23 patients (20 men, mean age of 64.0 +/- 9.7 years), with the same preoperative features, who underwent conventional CABG on the arrested heart using CPB.
Off-pump revascularization in end-stage renal disease patients showed a satisfactory incidence of mortality and morbidity rates. When compared with conventional CPB CABG group, off-pump patients had a lower incidence of bleeding, transfusions, ventilation support time, length of inotropic support and perioperative myocardial infarction. Also ICU and hospital stay and incidence of new-onset atrial fibrillation were lower in off-pump CABG patients.
In our experience, avoidance of CPB in end-stage renal disease patients was associated with an acceptable incidence of postoperative complications and of major adverse events. Off-pump CABG is a safe and effective method of myocardial revascularization in chronically dialyzed patients that should strongly be taken in consideration when planning the surgical strategy in this selected cohort of patients, although multicentric prospective randomized controlled trials are strongly recommended.
动脉粥样硬化性血管疾病是终末期肾病患者发病率和死亡率的主要原因。有几位作者报道，慢性透析患者在体外循环（CPB）下进行冠状动脉旁路移植术（CABG）时手术风险较高，而关于这些患者的非体外循环心肌血运重建的信息很少。
在 2000 年 1 月至 2008 年 12 月期间，我们中心连续为 17 例（12 名男性，平均年龄 62.3 +/- 12.3 岁）接受慢性血液透析的终末期肾衰竭患者进行了单纯非体外循环 CABG。为了评估这种方法，我们将非体外循环血运重建的结果与同期在相同术前特征的 23 例（20 名男性，平均年龄 64.0 +/- 9.7 岁）患者的结果进行了比较，这些患者在体外循环心脏骤停下进行了常规 CABG。
终末期肾病患者的非体外循环血运重建显示出令人满意的死亡率和发病率。与常规 CPB CABG 组相比，非体外循环患者的出血、输血、通气支持时间、正性肌力支持时间和围手术期心肌梗死发生率较低。非体外循环 CABG 患者的 ICU 和住院时间以及新发心房颤动的发生率也较低。
根据我们的经验，避免终末期肾病患者使用 CPB 与可接受的术后并发症和主要不良事件发生率相关。非体外循环 CABG 是一种安全有效的慢性透析患者心肌血运重建方法，在为这一选定患者群体制定手术策略时应强烈考虑，尽管强烈推荐进行多中心前瞻性随机对照试验。
