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Coronary Artery Bypass Grafting Surgery in Patients on Pre-operative Renal Replacement Therapy: safety and long-term survival
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
Raquel Moreira
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Posters
FP Number:
---
Authors:
Raquel Moreira; Francisca Saraiva; Rui Cerqueira; Ana f. Ferreira; Mário j. Amorim; António s. Barros; Paulo Pinho; André p. Lourenço; Adelino Leite-Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Despite the high risk for severe coronary artery disease, it remains controversial if patients in renal replacement therapy (RRT) can safely undergo coronary artery bypass grafting surgery (CABG).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To clinically characterize patients on pre-operative RRT who underwent CABG and their post-operative outcomes, namely immediate and long-term survival.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Retrospective single-centre study including patients on pre-operative RRT who required isolated CABG from 2004 to 2013. RRT was defined as either haemodialysis or peritoneal dialysis. Frequencies and proportions were obtained. Pre-operative data, postoperative complications, early and long-term survival were summarised. Maximum follow-up time was 15 years, median 9 years.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: We included 35 patients, mean age 62±11 years, 86% being male. Most patients (n=29, 88%) were on haemodialysis and presented frequently diabetes (63%), arterial hypertension (97%) and dyslipidaemia (60%). The pre-operative mean creatinine clearance (CrCl) was 29±32 mL/min and most patients were under beta-blocker (71%), statins (77%) and nitrates (64%). Twenty-one (68%) patients presented CCS class IV, most of them with mild left ventricular dysfunction (n=24, 71%). Fifteen patients (43%) had a recent acute myocardial infarction, 25 (71%) presented with 3-vessel disease and 19 (54%) as urgent surgery. On-pump CABG was used in 54% and 40% received a multiple arterial grafting approach. Post-operatively, 2 patients (6%) required inotropic support, 4 (13%) prolonged mechanical ventilation (>24h), 15 (43%) presented <em>de novo</em> atrial fibrillation and 1 (3%) had a stroke. These patients required an hospital stay of 14±11 days. Four patients required re-exploration of thorax: 2 due to bleeding and 2 due to sternal dehiscence. Regarding mortality, 2 patients (6%) died in the hospital or within the first 30 days after surgery and 25 patients deceased during the assessed follow-up. The 1-, 3-, 5- and 10-years cumulative survival were 89%, 69%, 51% and 32%, respectively.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Patients with terminal kidney disease requiring RRT who need to undergo CABG should go through a comprehensive clinical evaluation before surgery. Our results are in line with previous series; however, further studies are needed to confirm if CABG surgery provides a significant survival improvement in this subset of patients.</span></span></p>
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