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Year : 2018  |  Volume : 46  |  Issue : 2  |  Page : 152-161

Coronary artery bypass grafting surgery in chronic hemodialysis patients

1 Cardiac Surgery Department, Saud AlBabtin Cardiac Center, Dammam; Cardiac Surgery Department, Tanta University Hospitals, Tanta, Saudi Arabia
2 Cardiac Surgery Department, Saud AlBabtin Cardiac Center, Dammam, Saudi Arabia

Correspondence Address:
Ibrahim M Yassin
Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta 31111
Saudi Arabia
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DOI: 10.4103/tmj.tmj_8_18

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Background and aim Off-pump coronary artery bypass grafting (CABG) can be ideal for revascularization of chronic hemodialysis patients when the targets are easily accessible. Full revascularization usually necessitates the use of cardiopulmonary bypass (CPB) if the targets are not easily accessible. Either conventional CABG with cardioplegic arrest or on-pump beating-heart CABG can be used. The early and long-term outcomes are still controversial. We sought to compare the early and long-term outcomes of the three different methods of revascularization of this patient category. Patients and methods This was a retrospective analysis of randomized three selected equal groups, with 25 patients each revascularized with a different technique. Patients were operated from January 2008 to June 2016 in our institution. Group I underwent conventional CABG with cardioplegic arrest, group II underwent off-pump CABG, and group III underwent on-pump beating-heart CABG. Results The postoperative bleeding amount (P<0.001), length of hospital stay (P<0.001), and length of postoperative intensive care unit stay (P<0.001) were significantly lower in the off-pump and on-pump beating-heart CABG groups than in the conventional CABG group. No significant difference was found regarding 30-day mortality and morbidity rates including stroke, pneumonia, arrhythmia, intestinal complication, and low cardiac output syndrome. On-pump beating-heart CABG significantly reduced the duration of CPB compared with conventional CABG. There were no statistical differences in the freedom from cardiac events (P=0.143), but on-pump beating-heart CABG provided better long-term survival than conventional CABG (P≤0.01). Conclusion Off-pump CABG when safely implemented is the best option for complete revascularization of chronic hemodialysis patients. On-pump beating-heart CABG is a safe procedure that provides optimal operative exposure in chronic hemodialysis patients. The use of CPB and the elimination of cardioplegic arrest may be beneficial for the short-term and long-term survival of chronic hemodialysis patients.

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