- 期刊
Off-pump Coronary Artery Bypass (OPCAB) Is a Good Choice of Treatment for Hemodialysis-Dependent Uremic Patients with Severe Coronary Artery Disease
不停跳冠狀動脈繞道是洗腎嚴重冠心症患者之良好治療方式
並列摘要
Objective: Surgical revascularization for uremic coronary artery patients on hemodialyisis has been a challenge for cardiac surgeons. We carried out this retrospective analysis to evaluate the role of off-pump coronary artery bypass (OPCAB) for uremic coronary artery patients in a rural community hospital in southern Taiwan. Patients and Methods: A retrospective chart review was done of hemodialysis-dependent uremic patients who underwent OPCAB from July 2002 through August 2004. Thirteen patients were included (3 men and 10 women, mean age 65.4±8.4 years). All patients underwent hemodialysis 1 day before the operation, and they were scheduled for hemodialysis on the first or second day postoperatively. When there was an indication, urgent hemodialysis was performed immediately after the operation. Desmopressin (1-deamino-8-D-arginine vasopressin, abbreviated DDAVP) was administered preoperatively to enhance platelet function and the pericardial-shed blood was retrieved and reinfused intraoperatively to minimize blood loss. The postoperative care was the same as ordinary practice. Results: Nine of the 13 patients were unstable, and thus were operated on urgently or emergently. There was one death (7.7%), one mediastinitis (7.7%), and one mediastinal bleeding requiring reexploration (7.7%). There were no postoperative strokes. The average chest tube drainage amount was 735mL, and 12 (93.3%) patients needed blood transfusions. Only one (7.7%) patient needed urgent hemodialysis after the operation because of metabolic acidosis. The other patients did well with the scheduled hemodialysis. The average intensive care unit (ICU) and hospital stays were 2.8 and 13.3 days, respectively. One patient with preoperative repeated percutaneous nephrostomy infections developed sepsis, respiratory failure, and had prolonged mechanical ventilation and hospital stay. The others recovered uneventfully and no other postoperative infections were encountered. All patients had good symptomatic relief Conclusions: OPCAB is a good choice of treatment for hemodialysis-dependent uremic patients with severe coronary artery disease.