Avoidance of Dialysis in an End-Stage Renal Disease Patient Status-post Off-pump Coronary Artery Bypass Grafting

Document Type: Case Report

Authors

1 Research Assistant, University of Arizona College of Medicine, Tucson, Arizona, United States

2 General Surgeon, University of Arizona College of Medicine, Tucson, Arizona, United States

Abstract

Certain benefits are clearly associated with the use of off-pump coronary artery bypass grafting (CABG) as compared with the on-pump CABG. The superiority is more evident in patients with multiple co morbidities including renal failure.
We reviewed the medical records of a 67-year-old male with a past medical history that was significant for multiple cardiovascular diseases and new-onset end-stage renal disease. The case was suffering from dyspnea and work-up was suggestive of non-ST elevation myocardial infarction and congestive heart failure.
During the hospital course, he developed end-stage renal disease requiring hemodialysis. Further cardiac evaluation presented three-vessel coronary artery disease. The patient underwent off-pump CABG. Post-operatively, the patient had minimal complications and did not receive hemodialysis for 53 days.
Off-pump CABG has evident short-term benefits for patients with the end-stage renal disease requiring dialysis, including possible improvement in cardiac function and avoidance of hemodialysis

Keywords


  1. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009; 361:1827-37.
  2. Zamorano JA, Valenzuela JA, Garcia JE. Cirugía de revascularización coronaria:con o sin circulación extracorpórea? Estudios. 2011; 1:8.
  3. van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, et al. Early outcomes after off-pump versus on-pump coronary bypass surgery. Circulation. 2001; 104:1761-6.
  4. Emerson DA, Hynes CF, Trachiotis GD. Long-term outcomes after off-pump or conventional coronary artery bypass grafting within a veteran population. Innovations (Phila). 2015; 10:133-7.
  5. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012; 366:1489-97.
  6. Chawla LS, Zhao Y, Lough FC, Schroeder E, Seneff MG, Brennan JM. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol. 2012; 23:1389-97.
  7. Ngaage DL, Rogers S, Tang A, Sogliani F. On or off pump coronary bypass? Insight from matched and principal component analyses of 8779 operations. J Cardiovasc Surg (Torino). 2015; 56:447-54.
  8. Garcia Fuster R, Paredes F, Garcia Pelaez A, Martin E, Canovas S, Gil O, et al. Impact of increasing degrees of renal impairment on outcomes of coronary artery bypass grafting: the off-pump advantage. Eur J Cardiothorac Surg. 2013; 44:732-42.