Shayan Hossein, Rocha Rodolfo, Wei Lawrence, Gleason Thomas, Zaldonis Diana, Pellegrini Ronald, Toyoda Yoshiya, Shapiro Ron, Ahmad Ferhaan, Bermudez Christian
Department of Cardiothoracic Surgery, Thomas E. Starzl Transplantation Institute, and Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2011 Nov;26(6):591-5. doi: 10.1111/j.1540-8191.2011.01327.x. Epub 2011 Oct 14.
Renal transplant recipients have high mortality from cardiac causes and are frequently in need of coronary interventions. Surgical coronary revascularization is associated with significant morbidity and mortality in this patient population. This study was undertaken to evaluate outcomes of on-pump versus off-pump revascularization in renal transplant recipients.
We retrospectively reviewed 43 renal transplant recipients who underwent surgical coronary revascularization with functioning allografts. Revascularization was performed on-pump [coronary artery bypass grafting (CABG)] in 21 patients and off-pump [off-pump coronary artery bypass (OPCAB)] in 22 patients.
Preoperative characteristics did not differ between the two groups except for age and incidence of prior sternotomy. Total operative time and transfusion requirements were similar. The on-pump group received a higher number of bypass grafts (p = 0.03). Overall 30-day, one-year, five-year, and eight-year survival was 90%, 76%, 61%, and 32% for CABG group, and 95%, 86%, 62%, and 48% for OPCAB group (p = 0.53). The postoperative peak creatinine was higher in the CABG patients than in OPCAB patients (p = 0.04). At discharge, there was no difference in mean creatinine between the two groups. The rate of return to permanent dialysis after revascularization was similar (28% for CABG and 22% for OPCAB, p = 0.73). There was no difference in dialysis-free survival up to eight-years postrevascularization (p = 0.63).
Despite higher mortality risk, surgical coronary revascularization can be performed safely in renal transplant recipients. OPCAB resulted in no improvement in patient survival or renal allograft function compared to on-pump revascularization.
肾移植受者因心脏原因导致的死亡率较高，且经常需要进行冠状动脉干预。在这一患者群体中，外科冠状动脉血运重建与显著的发病率和死亡率相关。本研究旨在评估肾移植受者体外循环下与非体外循环下血运重建的结果。
我们回顾性分析了43例接受具有功能的同种异体移植肾外科冠状动脉血运重建的肾移植受者。21例患者接受体外循环下冠状动脉旁路移植术（CABG）进行血运重建，22例患者接受非体外循环下冠状动脉旁路移植术（OPCAB）进行血运重建。
除年龄和既往胸骨切开术发生率外，两组术前特征无差异。总手术时间和输血需求相似。体外循环组接受的旁路移植数量更多（p = 0.03）。CABG组的总体30天、1年、5年和8年生存率分别为90%、76%、61%和32%，OPCAB组分别为95%、86%、62%和48%（p = 0.53）。CABG患者术后肌酐峰值高于OPCAB患者（p = 0.04）。出院时，两组间平均肌酐无差异。血运重建后恢复永久性透析的比例相似（CABG为28%，OPCAB为22%，p = 0.73）。血运重建后长达8年的无透析生存率无差异（p = 0.63）。
尽管死亡风险较高，但肾移植受者仍可安全地进行外科冠状动脉血运重建。与体外循环下血运重建相比，OPCAB在患者生存率或肾移植功能方面并无改善。
