Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus

Ohira, Suguru; Doi, Kiyoshi; Numata, Shusuke; Yamazaki, Sachiko; Kawajiri, Hidetake

doi:10.1253/circj.cj-15-0776

Cited by 11 publications

(17 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As expected, octogenarians with incomplete revascularization had a greater prevalence of several comorbidities, including diabetes, kidney disease, peripheral vascular disease, mitral regurgitation, and three-vessel disease. Multivariate analysis confirmed that late death was dependent on specific patient comorbidities that are consistently associated with diminished survival, including diabetes mellitus, chronic renal disease, history of myocardial infarction, and advanced age [23,24]. However, multivariate analysis also showed that incomplete revascularization was a significant independent risk factor for mortality at 10 years.…”

Section: Commentmentioning

confidence: 78%

Complete Coronary Revascularization Improves Survival in Octogenarians

Melby

Saint

Balsara

et al. 2016

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

Section: Commentmentioning

confidence: 78%

Complete Coronary Revascularization Improves Survival in Octogenarians

Melby

Saint

Balsara

et al. 2016

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…In the authors' opinion, this case emphasizes the concept that both ITAs seem to be refractory to most aggressive forms of atherosclerosis (5), even in the presence of insulin-requiring status, renal failure, or long-standing immunomodulatory therapy (1,3,5,6). Besides, no sternal complications occurred after surgery and there were no symptoms of coronary steal despite the presence of a dialysis fistula ipsilateral to the composite in situ ITA graft (albeit it would always be preferable to avoid the use of an in situ ITA graft in the case of an ipsilateral arterovenous fistula due to the risk of myocardial ischemia during hemodialysis) (7).…”

Section: Discussionmentioning

confidence: 79%

“…Besides, no sternal complications occurred after surgery and there were no symptoms of coronary steal despite the presence of a dialysis fistula ipsilateral to the composite in situ ITA graft (albeit it would always be preferable to avoid the use of an in situ ITA graft in the case of an ipsilateral arterovenous fistula due to the risk of myocardial ischemia during hemodialysis) (7). Nevertheless, although there is increasing evidence of long-term survival benefits (1,(3)(4)(5)(6), many surgeons consider the use of both ITAs for myocardial revascularization as a too risky strategy that has to be adopted only for young and low-risk patients (8). Obviously, there are many factors that may affect the graft patency (primarily the coronary run-off), it is not a single (maybe) fortunate clinical case that may change the surgical practice, and the approach that is tailored to the baseline characteristics of each individual patient should always be preferred.…”

Section: Discussionmentioning

confidence: 99%

The Fate of a Composite Arterial Graft in a 58-Year-Old Man with Strong Comorbidities and Atherosclerotic Burden

Gatti¹,

Priolo²,

Benussi³

et al. 2016

Res Cardiovasc Med

View full text Add to dashboard Cite

Introduction: For some difficult subsets of coronary patients having specific co-morbidities, such as insulin-dependent diabetes and chronic renal failure arterial myocardial revascularization could be a satisfactory option. The key question is which arteries should be used. Case Presentation: A 58-year-old insulin-dependent diabetic patient with severe renal failure, despite previous kidney transplantation, underwent treatment of his severe and diffuse coronary disease using a composite arterial Y-graft and saphenous vein. Both internal thoracic arteries were harvested as skeletonized conduits. The patient's hospital course was totally uneventful. Fifty-six months later, the patient underwent hospital readmission due to a new (inferior) myocardial infarction. Coronary angiography showed both the progression of disease into native vessels and occlusion of the venous graft. The Y-graft was patent and wellfunctioning despite the presence of a preoperative left upper limb dialysis fistula. Conclusions: This case report emphasizes the concept that both internal thoracic arteries seem to be refractory to most aggressive forms of atherosclerosis, and that a more liberal use even for high-risk candidates could be a rational practice. However, many surgeons consider the use of both internal thoracic arteries for myocardial revascularization as a too risky strategy that has to be adopted only for young and low-risk patients.

show abstract

“…In the Society of Thoracic Surgeon database, operative mortality after CABG was 2.5% and ranged from 1.3% in patients with normal renal function to 9.3% for patients with GFR < 30 mL/min/1.73 m 2 and 9% for patients on dialysis before surgery . Similarly, high mortality was reported from a study from Japan in patients with ESRD on dialysis compared to those with normal to mild renal dysfunction (HR, 10.93; 95% CI: 5.93%‐20.16%) . Several randomized trials did not yield convincing evidence to support coronary revascularization before vascular surgery .…”

Section: End‐stage Renal Disease and Coronary Artery Diseasementioning

confidence: 98%

“…27 Similarly, high mortality was reported from a study from Japan in patients with ESRD on dialysis compared to those with normal to mild renal dysfunction (HR, 10.93; 95% CI: 5.93%-20.16%). 125 Several randomized trials did not yield convincing evidence to support coronary revascularization before vascular surgery. 126,127 Findings from these trials may not be applicable in patients waitlisted for kidney transplantation.…”

Section: End -S Tag E Renal D Is E a S E And Coronary Artery Dis E mentioning

confidence: 99%

Kidney transplantation and cardiomyopathy: Concepts and controversies in clinical decision‐making

Jha

Lata

2020

Clinical Transplantation

View full text Add to dashboard Cite

Increasing comorbidities and an aging population have led to a tremendous increase in the burden of both kidney and cardiac dysfunction. Concomitant cardiomyopathy exposes the patients with kidney disease to further physiological, hemodynamic, and pathologic alterations. Kidney transplantation imposes lesser anesthetic and surgical complexities compared to another solid organ transplant. The surgical decision‐making remains an unsettled issue in these conditions. The surgical choices, techniques, and sequences in kidney transplant and cardiac surgery depend on the pathophysiological perturbations and perioperative outcomes. The absence of randomized controlled trials eludes us from suggesting definite management protocol in patients with end‐stage kidney disease with cardiomyopathy. Nevertheless, in this review, we extracted data from published literature to understand the pathophysiologic interactions between end‐stage renal diseases with cardiomyopathy and also proposed the management algorithm in this challenging scenario. The proposed management algorithm would ensure consensus across all stakeholders involved in decision‐making. Our simplistic evidence‐based approach would augur future randomized trials and would further ensure refinement in our management approach after the emergence of more definitive evidence.

show abstract

Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus

Cited by 11 publications

References 35 publications

Complete Coronary Revascularization Improves Survival in Octogenarians

Complete Coronary Revascularization Improves Survival in Octogenarians

The Fate of a Composite Arterial Graft in a 58-Year-Old Man with Strong Comorbidities and Atherosclerotic Burden

Kidney transplantation and cardiomyopathy: Concepts and controversies in clinical decision‐making

Contact Info

Product

Resources

About