Impact of Arteriovenous Fistula for Hemodialysis on Clinical Outcomes of Coronary Artery Bypass
| Autor: | Wook Sung Kim, Pyo Won Park, Young Tak Lee, Dong Seop Jeong, Chang Seok Jeon, Hunbo Shim, Kiick Sung |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Arteriovenous fistula Coronary Artery Disease Internal thoracic artery 030204 cardiovascular system & hematology Chest pain 03 medical and health sciences Arteriovenous Shunt Surgical 0302 clinical medicine Renal Dialysis medicine.artery Ascending aorta medicine Humans Coronary Artery Bypass Mammary Arteries Renal Insufficiency Chronic Retrospective Studies business.industry Retrospective cohort study Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure 030228 respiratory system Coronary steal Female Hemodialysis medicine.symptom Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | The Annals of Thoracic Surgery. 106:1820-1826 |
| ISSN: | 0003-4975 |
| Popis: | Background This study compared clinical outcomes between the use of in situ and free internal thoracic artery grafts in patients with upper extremity arteriovenous fistula who underwent coronary artery bypass. Methods We reviewed 85 hemodialysis-dependent patients with upper extremity arteriovenous fistula who underwent coronary artery bypass with internal thoracic artery grafts. The patients were categorized into 2 groups; 48 (56%) with in situ graft ipsilateral to the arteriovenous fistula (group I) and 37 (44%) with free grafts anastomosed to the ascending aorta (group F). The follow-up period was 32.0 ± 38.1 months. Results The estimated overall survival rates at 3, 5, and 10 years were 89.5%, 81.6%, and 53%, respectively, for all discharged patients. There was no significant difference in in-hospital mortality, all-cause mortality, and freedom from major adverse cardiac events between the groups, although cardiac-related deaths occurred only in group I (n = 5). Ipsilateral in situ grafts were associated with hemodialysis-induced chest pain (odds ratio, 5.528; 95% confidence interval, 1.079 to 28.333; p = 0.040). The incidence of dialysis-induced chest pain in patients with in situ noncomposite, in situ composite, and free grafts was 45.5%, 19.4%, and 5.7%, respectively (p = 0.009). Conclusions Mortality was not influenced by using the internal thoracic artery as an ipsilateral in situ graft in patients with upper extremity arteriovenous fistula. However, there was a risk of increased incidence of hemodialysis-induced chest pain that is most likely related to coronary steal. A free internal thoracic artery graft would be an alternative option in these patients. |
| Databáze: | OpenAIRE |
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