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Baudo M, Torregrossa G, Dokollari A, Bisleri G, Bacco LD, Benussi S, Muneretto C, Rosati F. Impact of coronary-subclavian steal after surgical myocardial revascularization with internal thoracic artery in chronic hemodialysis patients: A meta-analysis. Trends Cardiovasc Med 2024; 34:183-190. [PMID: 36632858 DOI: 10.1016/j.tcm.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
Patients in hemodialysis with an arm arteriovenous fistula undergoing coronary artery bypass grafting (CABG) with an internal thoracic artery have been reported to suffer from coronary-subclavian steal (CSS) during dialysis session. However, its occurrence is still debated. A systematic literature review was performed to identify all studies investigating the occurrence of a CSS event in this subset of patients. The primary endpoint was the analysis of CSS and the following early and late survival outcomes. Independent determinants of CSS and the impact of the distance between the arteriovenous fistula (upper arm vs forearm) and the ipsilateral internal thoracic artery graft on CSS events and mortality were studied. Early and late survival outcomes were analyzed by comparing ipsilateral versus contralateral arteriovenous fistula. Of the 1,383 retrieved articles, 10 were included (n = 643 patients). The pooled event rate of CSS was 6.46% [95%CI=2.10-18.15], while of symptomatic CSS incidence was 3.99% [95%CI=0.95-15.25]. No survival differences were noted when comparing ipsilateral to contralateral arteriovenous fistula-internal thoracic artery combinations. On meta-regression, the upper arm was associated with more CSS events, while the forearm to lower late mortality rates. Independently from arteriovenous fistula-internal thoracic artery combination, CSS was not associated to higher mortality rates. Particular attention is warranted when selecting the type of conduits for CABG in patients with an arteriovenous fistula or if highly expected to need one in the near future after surgery. A contralateral arteriovenous fistula-internal thoracic artery combination is preferable. If this is not possible, a forearm arteriovenous fistula position should be preferred.
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Affiliation(s)
- Massimo Baudo
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili, 1, Brescia 25123, Italy.
| | - Gianluca Torregrossa
- Division of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, United States
| | - Aleksander Dokollari
- Division of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, United States
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, ON, Canada
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili, 1, Brescia 25123, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili, 1, Brescia 25123, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili, 1, Brescia 25123, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili, 1, Brescia 25123, Italy
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Shell D. Coronary Artery Bypass Grafting in Dialysis-Dependent Patients - Key Peri-Operative Considerations. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:73-80. [PMID: 37183155 DOI: 10.1016/j.carrev.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
Cardiovascular disease represents the leading cause of mortality in dialysis-dependent (DD) patients, with the great majority of these patients afflicted by severe coronary artery disease. As rates of end-stage renal disease increase worldwide, DD patients represent a growing proportion of the coronary artery bypass grafting (CABG) cohort. Yet, these patients are complex, with crucial changes in their haemodynamic and physiologic profiles that complicate revascularisation surgery. First, this comprehensive literature review explores the outcomes and prognostic factors for DD patients undergoing CABG. We then summarise the intricacies relating to important peri-operative decisions such as use of cardio-pulmonary bypass and choice of conduit.
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Affiliation(s)
- Daniel Shell
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne, St Vincent's Health Australia, Melbourne, Australia.
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Saito J, Kamiya S, Numata Y, Sasaki H, Asano M. Management of Coronary Artery Bypass Grafting Using an Arteriovenous Fistula: An Intraoperative Change in the Preoperative Plan. Cureus 2023; 15:e35517. [PMID: 37007373 PMCID: PMC10052507 DOI: 10.7759/cureus.35517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
Regarding coronary artery bypass grafting (CABG) in patients on hemodialysis, in situ internal thoracic artery (ITA) grafting of the left anterior descending artery (LAD) improves survival and freedom from cardiac events. Although a problem with the ITA can possibly occur, using the ITA ipsilateral to an arteriovenous fistula (AVF) in the upper extremity of patients on hemodialysis can cause coronary subclavian steal syndrome (CSSS). CSSS is a condition of myocardial ischemia caused by the diversion of blood flow from the ITA following coronary artery bypass surgery. CSSS has been reported to occur in cases of subclavian artery stenosis, AVF, and low cardiac function. A 78-year-old man with end-stage renal disease experienced angina pectoris during hemodialysis. The patient was scheduled for CABG, including anastomosis of the left internal thoracic artery (LITA) and LAD. After completion of all anastomoses, the LAD graft demonstrated retrograde blood flow, suggestive of ITA anomalies or CSSS. The LITA graft was transected at the proximal part and anastomosed to the saphenous vein graft with sufficient flow to the high lateral branch eventually.
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Hayashi J, Nakajima H, Asakura T, Iguchi A, Tokunaga C, Takazawa A, Chubachi F, Hori Y, Yoshitake A. Validity of Ipsilateral Internal Mammary Coronary Artery Bypass Graft of Arteriovenous Fistula. Heart Lung Circ 2022; 31:1399-1407. [PMID: 35840512 DOI: 10.1016/j.hlc.2022.06.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/28/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In coronary artery bypass grafting (CABG) for haemodialysis patients, arteriovenous fistula can reduce blood flow from the internal mammary artery (IMA) graft. The purpose of this study was to delineate the rationale of ipsilateral IMA grafting to the arteriovenous fistula by assessing graft flow and patency. METHOD The clinical records of 139 haemodialysis patients who underwent off-pump CABG, including IMA grafting to the left anterior descending artery (LAD) between April 2007 and December 2018, were retrospectively reviewed. Clinical outcomes and transit-time flowmetry results of IMA to LAD bypass grafts during off-pump CABG and postoperative angiography were examined. RESULTS An ipsilateral IMA to the arteriovenous fistula (Ipsi-IMA) was used in 89 patients, and a contralateral IMA to the arteriovenous fistula (Contra-IMA) was used in 50 patients and no hospital deaths occurred. The mean graft flow and angiographic patency rate did not differ between the Ipsi-IMA and Contra-IMA groups. In patients with 51 to 90% stenosis of LAD, there was no significant difference in the mean graft flow. In comparison, in the patients with 91 to 100% stenosis of LAD, the mean graft flow in the Ipsi-IMA group was significantly lower than that in the Contra-IMA group (p=0.03). Kaplan-Meier analyses showed a 5-year survival rate of 57.6% for Ipsi-IMA and 64.8% for Contra-IMA (p=0.47). CONCLUSIONS In the revascularisation of the LAD, the graft patency rate of the Ipsi-IMA was not inferior to that of the Contra-IMA. However, when the LAD has 91 to 100% stenosis, a Contra-IMA to arteriovenous fistula may be beneficial in terms of sufficient flow capacity.
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Affiliation(s)
- Jun Hayashi
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshihisa Asakura
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsushi Iguchi
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akitoshi Takazawa
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Fumiya Chubachi
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuto Hori
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
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Influence of Ipsilateral Graft Inflow to Arteriovenous Fistula for Hemodialysis in Coronary Bypass Surgery. J Clin Med 2022; 11:jcm11041053. [PMID: 35207327 PMCID: PMC8880524 DOI: 10.3390/jcm11041053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
In coronary artery bypass grafting (CABG) for patients on hemodialysis, there has been concern about “coronary steal”. This study aims to evaluate the influence of using an in situ internal thoracic artery (ITA) ipsilateral to a preexisting arteriovenous fistula (AVF) in dialysis-dependent patients undergoing CABG. Between 2004 and 2018, dialysis-dependent patients with AVFs who underwent CABG were enrolled. According to the locational relationship of AVFs and in situ ITA grafts, the patients were divided into the ipsilateral group (n = 22) and the contralateral group (n = 21). Inverse probability weighting analysis was used to estimate and compare the late clinical outcomes. The late cardiac-related adverse events were not significantly different between the two groups: “major adverse cardiovascular and cerebrovascular events (MACCE)” (p = 0.090), “composite outcome of recurrent angina and coronary re-intervention” (p = 0.600). The in situ ITA graft of CABG on the ipsilateral side to AVF was not a significant risk factor for MACCE or the composite outcome of recurrent angina and coronary re-intervention. There was no statistically significant difference in the graft patency between the groups. Therefore, it might not be necessary to avoid using an in situ ITA on the ipsilateral side of an upper-arm AVF for optimal coronary artery bypass grafting in dialysis-dependent patients.
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Hachiro K, Kinoshita T, Suzuki T, Asai T. Internal thoracic artery graft ipsilateral to the arteriovenous fistula in haemodialysis patients. Interact Cardiovasc Thorac Surg 2021; 32:864-872. [PMID: 33561216 DOI: 10.1093/icvts/ivab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 01/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the impact of in situ internal thoracic artery (ITA) grafting ipsilateral to the arteriovenous fistula (AVF) on postoperative outcomes in haemodialysis patients undergoing isolated coronary artery bypass grafting (CABG). METHODS We reviewed 132 haemodialysis patients who underwent isolated CABG between January 2002 and December 2019. With a difference between the left and right upper arms blood pressure measurement of ≥20 mmHg, we did not use the ITA on the lower value side. We categorized patients into 55 patients (41.7%, ipsilateral group) whose left anterior descending artery was revascularized using the in situ ITA ipsilateral to the AVF, and 77 patients (58.3%, contralateral group) whose left anterior descending artery was revascularized using the ITA opposite the AVF. We compared patients' postoperative outcomes after adjusting for their backgrounds using weighted logistic regression analysis and inverse probability of treatment weighting. RESULTS No patients developed coronary steal postoperatively, and there was no significant difference in 30-day mortality between the groups (P = 0.353). The adjusted 5-year estimated rates of freedom from all-cause and cardiac death in the ipsilateral vs contralateral groups were 52.3% vs 54.0% and 78.2% vs 88.6%, respectively; survival curves were not statistically significantly different (P = 0.762 and P = 0.229, respectively). CONCLUSIONS In situ ITA grafting ipsilateral to the AVF was not associated with postoperative early and mid-term worse outcomes in haemodialysis patients undergoing isolated CABG.
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Affiliation(s)
- Kohei Hachiro
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takeshi Kinoshita
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tohru Asai
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Translational Sciences in Cardiac Failure Secondary to Arteriovenous Fistula in Hemodialysis Patients. Ann Vasc Surg 2021; 74:431-449. [PMID: 33556504 DOI: 10.1016/j.avsg.2021.01.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/08/2020] [Accepted: 01/03/2021] [Indexed: 01/07/2023]
Abstract
High-output cardiac failure is a rare form of heart failure associated with the formation of arteriovenous fistula (AVF) in hemodialysis patients. The pathophysiology underlying the HOCF is complex and multifactorial. Presence of AVF can cause long term hemodynamic changes that ultimately lead to increased cardiac output and consequently cardiac failure. A number of risk factors have been associated with the development of HOCF post-AVF construction, including male sex, a proximally located AVF and a state of volume overload. Dysregulation of tissue inhibitor of matrix metalloproteinase 4, Sirtuin-1 and Sirtuin-3 gene expression have been associated with the development of heart failure. The differences observed between genders have been attributed to altered activity of the β-adrenoceptor system. Numerous biomarkers including cardiac troponin T and I, atrial natriuretic peptide, brain natriuretic peptide among others have shown both prognostic and diagnostic potential; however further research is needed to establish their utility in clinical practice for patients with AVF associated HOCF. In recent years risk stratification models have been developed to help identify patients at the highest risk of developing HOCF post AVF which could be revolutionary in its identification and management. Potential options for managing HOCF post-AVF include AVF ligation, banding and anastoplasty however these procedures are not without their own associated risks. In this review, we discuss the pathophysiology, risk stratification and management of patients with AVF associated HOCF.
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Pang PYK, Teow CKJ, Huang MJ, Naik MJ, Lim SL, Chao VTT, Tan TE, Chua YL, Sin YK. Long-term prognosis in patients with end-stage renal disease after coronary artery bypass grafting. J Thorac Dis 2020; 12:6722-6730. [PMID: 33282373 PMCID: PMC7711392 DOI: 10.21037/jtd-20-2046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Coronary artery bypass grafting (CABG) is beneficial in selected patients with ESRD. This study investigates the survival outcomes and prognostic factors in ESRD patients who underwent CABG. Methods A retrospective analysis was performed for 149 patients with ESRD who underwent isolated CABG between 2006 and 2015. Results Mean age was 59.4±8.7 years and 106 patients (71.1%) were male. Operative mortality occurred in 20 patients (13.4%). Overall survival was 81.1%±3.2% at 1 year, 41.5%±4.3% at 5 years and 19.2%±4.2% at 10 years. Median survival was 4.3 years. Multivariable analysis identified age [P=0.001, odds ratio (OR): 1.15 per 1-year increase, 95% confidence interval (CI): 1.06-1.25], preoperative left ventricular ejection fraction (LVEF) (P=0.020, OR: 0.94, 95% CI: 0.89-0.99) and non-elective status of operation (P=0.049, OR: 3.34, 95% CI: 1.00-11.1) as predictors of operative mortality. Cox regression analysis identified age [P<0.001, hazard ratio (HR): 1.05 per 1-year increase, 95% CI: 1.03-1.08], New York Heart Association (NYHA) class III or IV status (P=0.010, HR: 1.75, 95% CI: 1.15-2.67) and the use of a left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) graft (P=0.029, HR: 0.42, 95% CI: 0.19-0.92) as factors influencing long-term survival. Conclusions CABG is associated with high operative mortality and poor long-term survival in ESRD patients. Age and NYHA class influenced late survival. LIMA-LAD grafting conferred a long-term survival advantage.
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Affiliation(s)
- Philip Y K Pang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Christopher K J Teow
- Ministry of Health Holdings, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ming Jie Huang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Madhava J Naik
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - See Lim Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Teing Ee Tan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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Wu YS, Hsieh SR, Wei HJ, Hsu CY, Tsai CL. Long-Term Outcomes in Coronary Artery Bypass Graft Patients Using Internal Thoracic Artery with Ipsilateral Arteriovenous Shunt for Hemodialysis. ACTA CARDIOLOGICA SINICA 2019; 35:387-393. [PMID: 31371899 DOI: 10.6515/acs.201907_35(4).20181208a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The goal of this study was to evaluate the long-term results of coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) grafts in hemodialysis (HD) patients with arteriovenous (AV) fistulae or AV grafts involving the ipsilateral or contralateral brachial artery or radial artery. Methods From March 2007 to May 2017, 76 end-stage renal disease (ESRD) patients with an upper limb AV fistula or graft for HD underwent CABG at a single center. Group A included 23 patients who underwent CABG using an ITA graft ipsilateral to the AV vascular access (AVVA); Group B included 22 patients who underwent CABG using a contralateral ITA with AVVA; and Group C included 29 patients who underwent CABG with AVVA without the use of an ITA graft. The primary end-point was death from any cause. Results The average follow-up period was 34.4 ± 26.9 months. Death from any cause occurred in 6 (26.09%) patients in Group A, 8 (36.36%) patients in Group B, and 17 (58.62%) patients in Group C (log-rank p = 0.04). There was no significant difference in death rate between Groups A and B. The risk of death was lower in the patients with CABG using an ITA graft (ITA CABG) compared to the patients without ITA CABG [HR 0.41 (95% CI, 0.20-0.84), p = 0.015]. Conclusions The HD patients who underwent CABG with an ipsilateral location of the ITA and AVVA did not have an increased risk of death compared to the patients who underwent CABG with a contralateral location of the ITA and AVVA. In addition, the use of ITA in CABG resulted in better outcomes in the HD patients.
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Affiliation(s)
- Yung-Szu Wu
- Department of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Shih-Rong Hsieh
- Department of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung.,National Yang-Ming University School of Medicine, Taipei
| | - Hao-Ji Wei
- Department of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung.,National Yang-Ming University School of Medicine, Taipei
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Lin Tsai
- Department of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung
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Tam DY, Rahouma M, An KR, Gaudino MF, Karkhanis R, Fremes SE. Bilateral versus single internal thoracic artery for coronary artery bypass grafting with end‐stage renal disease: A systematic review and meta‐analysis. J Card Surg 2019; 34:196-201. [DOI: 10.1111/jocs.14010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Derrick Y. Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoToronto Canada
| | - Mohamed Rahouma
- Department of Cardiothoracic SurgeryWeill Cornell Medical CollegeNew York New York
| | - Kevin R. An
- Division of Cardiac Surgery, Schulich Heart Centre, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoToronto Canada
| | - Mario F.L. Gaudino
- Department of Cardiovascular SciencesCatholic UniversityRome Italy
- Department of Cardiothoracic SurgeryWeill Cornell Medical CollegeNew York New York
| | - Reena Karkhanis
- Division of Cardiac Surgery, Schulich Heart Centre, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoToronto Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of SurgerySunnybrook Health Sciences Centre, University of TorontoToronto Canada
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Shim H, Jeong DS, Kim WS, Park PW, Sung K, Jeon CS, Lee YT. Impact of Arteriovenous Fistula for Hemodialysis on Clinical Outcomes of Coronary Artery Bypass. Ann Thorac Surg 2018; 106:1820-1826. [DOI: 10.1016/j.athoracsur.2018.06.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Hollander KN, Goeddel LA. Management of Arteriovenous Fistulas in Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:2243-2245. [PMID: 30467030 DOI: 10.1053/j.jvca.2018.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lee Andrew Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
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Han Y, Choo SJ, Kwon H, Lee JW, Chung CH, Kim H, Kwon TW, Cho YP. Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass grafting. PLoS One 2017; 12:e0184168. [PMID: 28873444 PMCID: PMC5584927 DOI: 10.1371/journal.pone.0184168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/18/2017] [Indexed: 12/03/2022] Open
Abstract
The present study was conducted to investigate whether upper-extremity vascular access (VA) creation increases the risk for major adverse cardiac events (MACE) and death in patients undergoing coronary artery bypass grafting (CABG) with an in situ left internal thoracic artery (ITA) graft. A total of 111 patients with CABG with a left ITA graft who underwent upper-extremity VA creation were analyzed retrospectively; 93 patients received left VA creation (83.8%, ipsilateral group) and 18 patients received right VA creation (16.2%, contralateral group). The primary outcome was the occurrence of MACE, and the secondary outcome was the composite of MACE or late death. There were no significant differences in the incidence of primary (P = 0.30) or secondary (P = 0.09) outcomes between the two groups. Multivariate regression analysis indicated that prior cerebrovascular accidents (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.37–7.97; P = 0.01) and type of VA (HR 3.44; 95% CI 1.34–8.82; P = 0.01) were independently associated with MACE; prior peripheral arterial occlusive disease (HR 4.22; 95% CI 1.62–10.98; P<0.01) and type of VA (arteriovenous fistula vs. prosthetic arteriovenous grafting) (HR 3.06; 95% CI, 1.42–6.61; P<0.01) were associated with the composite of MACE or death. The side and location of VA were not associated with MACE or death. Our study showed no definite evidence that ipsilateral VA creation affects the subsequent occurrence of MACE or late death from any cause. The type of VA (a prosthetic arteriovenous grafting) is a significant predictor of the subsequent occurrence of MACE or late death.
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Affiliation(s)
- Youngjin Han
- Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Hyunwook Kwon
- Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Thoracic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Hyangkyoung Kim
- Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Tae-Won Kwon
- Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Yong-Pil Cho
- Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
- * E-mail:
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14
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The incidence and risk factors of coronary steal after ipsilateral AVF in patients with a coronary artery bypass graft. J Vasc Access 2017; 18:290-294. [DOI: 10.5301/jva.5000690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/20/2022] Open
Abstract
Objective Ipsilateral arteriovenous fistula (AVF) may cause symptoms of coronary steal in patients who had undergone coronary artery bypass graft (CABG) using internal thoracic artery. The purpose of this study was to evaluate the adverse effects of ipsilateral AVF to CABG, including the incidence of coronary steal, and to analyze the risk factors for coronary steal. Methods Between 2000 and 2013, a total of 25 patients undergoing hemodialysis via upper extremity AVF, ipsilateral to the preexisting CABG, were reviewed retrospectively. Clinical assessment related to coronary steal, echocardiography before AVF, and coronary angiography after symptoms were assessed. The definition of coronary steal was the new development of one or more of the following symptoms within 12 weeks after AVF creation: chest pain, chest discomfort, and dyspnea. Results Three patients were clinically diagnosed as coronary steal. Left ventricular ejection fraction (LVEF) was statistically lower in coronary steal group compared to no-steal group (41.7% vs. 50.9%; p = 0.036). Patients with coronary steal were older at the age of CABG surgery and showed a higher incidence of regional wall motion abnormality. Conclusions Coronary steal after ipsilateral AVF creation in patients with CABG using in situ internal thoracic artery (ITA) developed in 12%, which can be related to low LVEF. In patients with CABG requiring AVF for hemodialysis, the ipsilateral fistula to the grafted ITA should be carefully selected and performed.
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Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery. J Vasc Access 2017; 18:301-306. [DOI: 10.5301/jva.5000693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background The possibility of coronary steal through an arteriovenous fistula (AVF) in hemodialysis (HD) patients with coronary artery bypass grafts (CABGs) using an ipsilateral internal thoracic artery (ITA) has been suggested. In order to define the significance of such a possibility, we analyzed cardiac events and mortality risk in patients in relation to AVF flow. Methods A retrospective cohort study was performed on prevalent HD patients from a single center. The outcomes included a first cardiac event, cardiac death and death from any cause. Results The group consisted of 23 chronic HD patients having ITA CABG and upper extremity AV access, 12 patients had an ipsilateral and 11 patients had a contralateral location of ITA CABG and an upper extremity AV access. The mean follow-up period was for 37.0 months. Multivariable Cox proportional-hazards regression analysis of risk of death from any cause in relation to AV access flow showed no increased risk, neither in the group with ipsilateral location of ITA grafts and dialysis accesses (adjusted HR, 3.047 [95% CI, 0.996 to 1.000], p = 0.081), nor in the group with contralateral location of both shunts (adjusted HR, 0.173 [95% CI, 0.997 to 1.002], p = 0.678). There was no significant correlation between AV access blood flow and the risk of first cardiac event as well as cardiac death in either study group. Conclusions In this study on HD patients having ipsilateral ITA CABG and AVF, fistula flow rate was not found to be associated with mortality or cardiac risk.
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Hsu CY, Chen YS. Coronary artery revascularization in hemodialysis patients with multivessel coronary artery disease. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rao NN, Dundon BK, Worthley MI, Faull RJ. The Impact of Arteriovenous Fistulae for Hemodialysis on the Cardiovascular System. Semin Dial 2016; 29:214-21. [DOI: 10.1111/sdi.12459] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nitesh N. Rao
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Victoria Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Randall J. Faull
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
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Alkhouli M, Sandhu P, Boobes K, Hatahet K, Raza F, Boobes Y. Cardiac complications of arteriovenous fistulas in patients with end-stage renal disease. Nefrologia 2015; 35:234-45. [PMID: 26299166 DOI: 10.1016/j.nefro.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Abstract
Cardiovascular disease is the leading cause of the death in dialysis patients. Arteriovenous fistulas (AVFs) are associated with lower mortality and are viewed as the desired access option in most patients with advanced kidney disease needing dialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. This article provides a comprehensive and contemporary review to what is known about the impact of AVFs on: congestive heart failure, left ventricular hypertrophy, pulmonary hypertension, right ventricular dysfunction, coronary artery disease and valvular heart disease.
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Affiliation(s)
- Mohamad Alkhouli
- Cardiology Department, University of Rochester, Rochester, NY, USA.
| | - Paul Sandhu
- Department of Internal Medicine, Boston University, Boston, MA, USA
| | - Khlaed Boobes
- Department of Nephrology, Northwestern University, Chicago, IL, USA
| | - Kamel Hatahet
- Department of Nephrology, Temple University Hospital, Philadelphia, PA, USA
| | - Farhan Raza
- Cardiology Department, Temple University Hospital, Philadelphia, PA, USA
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Cuthbert GA, Kirmani BH, Muir AD. Should dialysis-dependent patients with upper limb arterio-venous fistulae undergoing coronary artery bypass grafting avoid having ipsilateralin situmammary artery grafts?: Table 1:. Interact Cardiovasc Thorac Surg 2014; 18:655-60. [DOI: 10.1093/icvts/ivt559] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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