Abstract
Background: Operative mortality after coronary artery bypass grafting (CABG) with end-stage renal disease (ESRD) on hemodialysis (HD) is high. To improve early results, we aggressively selected off-pump coronary artery bypass graft (OPCAB). Since complete revascularization was sometimes difficult because of diffuse calcification, a preoperative cardiac computed tomography (CT) was used for complete revascularization using bilateral internal thoracic arteries (BITA). Methods: We reviewed thirteen patients on HD, including two patients with ischemic mitral regurgitation (IMR), who underwent CABG from April 2010 through July 2011. The period of HD was 7.2±6 years; wherein, nine of 13 patients had diabetic nephropathy. Results: OPCAB was completed in all cases, except for the two IMR. There was no operative mortality. One postoperative deep wound infection was completely cured by vacuum associated closure. In situ BITA usage rate of 89% and complete revascularization rate of 92% were comparable in the patients without ESRD. Median time of ventilation was 4.8 hours, feeding was resumed on the second day, and ambulation was initiated on 2.5 days. ITA patency rate confirmed by angiogram was 100%, and Fitz-Gibbon A accounted for 96%. Although 1 year survival rate was a 77%, freedom from cardiac event excluding non-cardiac death was 100%. Conclusion: In patients with ESRD on HD, preoperative cardiac CT was crucial in deciding the appropriate site of anastomosis. OPCAB improved operative mortality, and complete revascularization with in situ BITA was an acceptable strategy, which could improve long term outcome.
