血液透析患者における冠状動脈バイパス手術の長期成績

DOI 被引用文献2件 参考文献19件

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  • Long-term outcome of coronary artery bypass grafting in patients receiving dialysis

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Coronary artery bypass grafting (CABG) is increasingly being performed in chronic dialysis patients. Although postoperative short-term CABG outcomes have been reported, indicating stable results, the long-term outcomes of surgery have rarely been reported. Therefore, we investigated the long-term outcomes of CABG at this hospital. Seventy-seven patients receiving dialysis regularly between January 1983 and December 1999, who underwent CABG only were studied. The patients ranged in age from 40 to 76 years, and consisted of 61 males and 16 females. Among these, the mean preoperative dialysis period was 6 years. The underlying disease that made dialysis necessary was diabetes mellitus (DM) in 32 patients, chronic glomerulonephritis (CGN) in 27, nephrosclerosis (NS) in 10, and other in 8. Our guidelines for surgery were that it be performed under extracorporeal hypothermic cardiac arrest as a rule and performed under beating heart if the patient had central nervous system complications. Patients received dialysis for 2 days preoperatively, received dialysis while extracorporeal circulation was being used, and began postoperative dialysis on day 2. Eight patients died during their hospital stay, of whom 3 died of digestive-tract bleeding, 2 of sepsis, and 1 each of brain death, arrhythmia, and cardiogenic shock. Of these 8 patients, 5 had DM as the underlying disease. There were 24 deaths during long-term follow-up, of which 4 were due to acute myocardial infarction, 2 to cardiac failure, 9 to dialysis encephalopathy, 2 to cerebral hemorrhage, 1 each of malignant tumor, hyperkalemia, weakness, and purulent pleurisy, 2 to sudden death, and 8 due to unknown causes. The diseases requiring dialysis among patients who died during long-term follow-up were DM (10 cases), CGN (7), NS (4), and other diseases (3). The cumulative survival rate was 0.699 at 3 years, 0.577 at 5 years, and 0.425 at 7 years, when classified by diseases that made dialysis necessary, cumulative survival rates among patients with DM were 0.665 at 3 years, 0.332 at 5 years, and 0.166 at 7 years, while the rates among patients with CGN were 0.798 at 3 years, 0.798 at 5 years, 0.709 at 7 years, and 0, 709 at 10 years. The long-term outcome of CABG in chronic dialysis patients was unsatisfactory. Although the outcome of CABG was favorable in patients with CGN, it was unfavorable in patients with DM. Therefore, we recommend that CABG be indicated cautiously for DM patients.

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