慢性透析患者の冠動脈バイパスにおける， vascular access側の内胸動脈グラフトの検討

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  • Clinical outcome of OPCAB using an ipsilateral ITA graft in chronic hemodialysis patients with upper extremity vascular access

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From October 2000 to March 2011, 1391 consecutive patients underwent isolated OPCAB. Of these patients, 129 were on HD, and 111 patients underwent in situ ITA revascularization of LAD. An ipsilateral ITA graft to vascular access was used in 85 patients (IL group), while a contralateral ITA graft was used in 26 (CL group). The outcomes were retrospectively compared between the groups. The mean diameter of ITA as measured by preoperative TTE (rt 2.2 mm, lt 2.2 mm vs rt 2.3 mm, lt 2.2 mm, P=0.90, 0.88) and the intraoperative ITA graft flow according to an ultrasonic flow-meter (35.7 ml/min vs 43.2 ml/min, P=0.147) and the peak diastolic/systolic velocity according to early postoperative TTE (29.5/42.3 vs 30.1/42.4, P=0.843/0.983) were both similar between the IL and CL groups. No significant difference was observed regarding in-hospital mortality (5.9% vs 3.8%, P=0.69). The 1-, 3-, and 5-year survival ratio was 85%, 75%, and 56% in the IL group and 85%, 54%, and 34% in the CL group, respectively . Using of an ipsilateral ITA graft did not reduce the graft flow velocity during the intraoperative or early postoperative periods. No significant difference was observed between the two groups regarding mortality. From these results, both ITAs in HD patients are available for revascularization of LAD.

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