The Futility of Pretransplant Coronary Bypass Grafting in Asymptomatic Patients on Peritoneal Dialysis

1998 ◽  
Vol 18 (5) ◽  
pp. 485-488 ◽  
Author(s):  
S. Panduranga Rao ◽  
Susan Lenkei ◽  
Maggie Chu ◽  
Joanne M. Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Comparison Group ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Study Group ◽  
Bypass Grafting ◽  
Comorbid Disease ◽  
Dialysis Patients ◽  
Asymptomatic Patients

Objective To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia. Design Retrospective review in a single PD unit. Participants Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group. Ten age-, sex-, and diseasematched PD patients who did not receive CABG were used as a comparison group. Measurements Clinical outcome from 1990 to the present. Results Only 1 patient in the study group has received a transplant. Seven patients (70%) have died or have been removed from the list because of comorbid illness. Only 2 patients are still on the waiting list. Conclusion As a result of the long waiting time for cadaveric renal transplant and the high risk of interim development of comorbid disease, only a minority of patients come to transplantation. The presence of coronary disease is likely a surrogate for more generalized cardiac and vascular disease in this population. In light of these findings, the policy of prophylactic revascularization in asymptomatic dialysis patients in preparation for renal transplantation needs to be reconsidered.

A Case Report on Concomitant Coronary Artery Bypass Operation and Renal Transplantation

2014 ◽  
Vol 17 (3) ◽  
pp. 180
Author(s):  
Yucel Ozen ◽  
Sabit Sarikaya ◽  
O. Atlas ◽  
D. Cekmecelioglu ◽  
Kann Kirali ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Renal Transplantation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Asymptomatic Patients ◽  
Artery Disease

Renal transplantation is successfully implemented in patients undergoing coronary bypass surgery. We performed concomitant coronary bypass surgery and renal transplantation in a patient found to have a left main coronary artery lesion after coronary angiography, which was performed in our clinic during preoperative evaluation of renal transplantation. We suggest the application of coronary-artery bypass grafting (CABG) or stent implantation 2 months after renal transplantation in asymptomatic patients with coronary artery disease. But, if severe coronary artery disease is detected in symptomatic patients, we suggest the concurrent application CABG and renal transplantation.

The Comparison between Minimally Invasive Coronary Bypass Grafting Surgery and Conventional Bypass Grafting Surgery in Proximal LAD Lesion

2015 ◽  
Vol 18 (2) ◽  
pp. 042 ◽  
Author(s):  
Mehmet Ezelsoy ◽  
Baris Caynak ◽  
Muhammed Bayram ◽  
Kerem Oral ◽  
Zehra Bayramoglu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Robotic Group ◽  
Bypass Group

<strong>Background</strong>: Minimally invasive bypass grafting surgery has entered the clincal routine in several centers around the world, with an increasing popularity in the last decade. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal left anterior descending artery (LAD) lesions. <br /><strong>Methods</strong>: Between January 2004 and December 2011, patients with proximal LAD lesions, who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery, were included in the study. In Group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy were applied to 35 patients and in Group 2, robotically assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative, and postoperative data were collected retrospectively.<br /><strong>Results</strong>: The mean follow-up time of the conventional bypass group was 5.7 ± 1.7 years, whereas this ratio was 7.3 ±1.3 in the robotic group. There was no postoperative transient ischemic attack (TIA), wound infection, mortality, or need for intra-aortic balloon pump (IABP) in any of the patients. In the conventional bypass group, blood transfusion and ventilation time were significantly higher (P &lt; .05) than in the robotic group. The intensive care unit (ICU) stay and hospital stay were remarkably shorter in the robotic group <br />(P &lt; .01). The postoperative pneumonia rate was significantly higher (20%) in the conventional bypass group <br />(P &lt; .01). Postoperative day 1 pain score was higher in the robotic group (P &lt; .05), however, postoperative day 3 pain score in the conventional bypass group was higher (P &lt; .05). Graft patency rate was 88.6% in the conventional bypass group whereas this ratio was 91.4% in the robotic bypass group, which was not clinically significant (P &gt; .05).<br /><strong>Conclusion</strong>: In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

Overview of blood purification in uremia

1980 ◽  
Vol 3 (4) ◽  
pp. 203-208
Author(s):  
B.T. Burton
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Rejection Rate ◽  
Blood Purification ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Transplant Patients ◽  
Maintenance Dialysis ◽  
Transplanted Kidneys

Today, management of irreversible renal failure is based primarily on maintenance hemodialysis and renal transplantation with a growing minority of patients treated by peritoneal dialysis. With regard to renal transplantation — the early promise of renal transplantation in the mid 1960's has given way to the realities of the late 1970's. There have been no major changes in the rejection rate of transplanted kidneys in recent years though today's mortality of transplant patients is considerably reduced over what it used to be. Moreover, universally the lack of availability of a sufficient number of organs for transplantation poses a formidable problem. It is all too apparent that current methods of blood purification in uremia are far from optimal. Even though the mortality in maintenance dialysis is relatively low, hemodialysis is characterized by a variety of complications and most maintenance dialysis patients are not optimally rehabilitated.

Early and long-term results of coronary artery bypass grafting in dialysis patients

2000 ◽  
Vol 70 (3) ◽  
pp. 813-818 ◽  
Author(s):  
Dion L Franga ◽  
John M Kratz ◽  
A.Jackson Crumbley ◽  
James L Zellner ◽  
Martha R Stroud ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Bypass Grafting ◽  
Dialysis Patients ◽  
Artery Bypass Grafting

Percutaneous coronary intervention for unprotected and protected left main stem disease

2010 ◽  
pp. 313-332
Author(s):  
Christine Hughes ◽  
Bruno Farah ◽  
Jean Fajadet
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Coronary Bypass Grafting ◽  
Percutaneous Coronary

Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing coronary angiography (and patients with ULMCA disease treated medically have a 3-year mortality rate of 50%. Several studies have shown a significant benefit following treatment of left main (LM) stenosis with coronary bypass grafting compared with medical treatment. Until recently coronary bypass grafting has been the gold standard therapy for LM disease. However, advances in percutaneous intervention techniques and stent technology have allowed re-evaluation of the role of percutaneous coronary intervention (PCI) for LM disease. Recent studies have focused on the safety and efficacy of stenting the left main coronary artery (LMCA) to determine if it does provide a true alternative to coronary artery bypass grafting (CABG). So should we stent the LM?

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