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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1975 and 1979 we performed coronary arteriography on 15 patients with end-stage renal failure and clinical evidence of severe ischemic heart disease. One patient died after the procedure of severe pump failure. Ten patients subsequently received coronary-artery bypass grafts, and two of these patients also received mitral-valve replacement. One patient, a diabetic, died of sepsis after surgery. Eight of the nine surviving patients, including the two patients who had undergone mitral-valve replacement, are markedly improved as a result of surgery. Our experience indicates that these patients can undergo angiography and coronary-artery bypass surgery at an increased but acceptable risk, provided dialysis is done before and after cardiac catheterization and surgery to control extracellular volume overload and hyperkalemia. The operation benefits patients with end-stage renal failure and severe ischemic heart disease by relieving angina and improving their level of activity. It is unclear whether survival is improved for these patients.
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PMID:Coronary-artery surgery in patients with end-stage renal disease. 696 31

After successful renal transplantation, seven diabetic renal failure patients with severe coronary artery disease returned to productive employment. Despite the requirement for additional peripheral vascular or ophthalmologic surgery in four patients, their renal function remained adequate. Following transplantation, diabetic complications included angina in three, myocardial infarction in three, and cerebrovascular accident in two patients. Two patients with adequate renal function died suddenly at 29 and 62 mo. Despite severe coronary artery disease, an increasing number of diabetic dialysis patients may be able to return to work after a successful kidney transplant.
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PMID:Improving survival after renal transplantation for diabetic patients with severe coronary artery disease. 704 15

Two hundred twenty patients, preferentially those with high-risk conditions, underwent coronary artery bypass grafting without cardiopulmonary bypass. Early unfavorable outcome events included operative mortality (7 patients, 3.2%), nonfatal perioperative myocardial infarction (6 patients, 2.7%), cerebrovascular accident (1 patient, 0.4%), and sternal infection (3 patients, 1.4%). There were two deaths (13%) among 15 patients with calcified aorta and four (12%) in 33 patients who underwent emergency operation. Multivariate analysis revealed these two risk factors to be the only predictors of early mortality (odds ratios, 8.0 and 9.8, respectively). Preoperative risk factors such as left ventricular dysfunction (ejection fraction < or = 35%) (40 patients, 18%), congestive heart failure (46 patients, 21%), acute myocardial infarction (59 patients, 27%), cardiogenic shock (7 patients, 3%), age 70 years or older (59 patients, 27%), renal failure (19 patients, 9%), and cerebrovascular accident and carotid disease (11 patients, 5%) were not found to be major predictors of early mortality or unfavorable outcome. During 12 months of follow-up (range 1 to 21 months), there were four cardiac and three noncardiac deaths (1-year actuarial survival 93%) and 17 cases (7.7%) of early return of angina. Calcified aorta, nonuse of the internal mammary artery, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that coronary artery bypass grafting without cardiopulmonary bypass can be done with relatively low operative mortality, although there seems to be an increased risk for early return of angina. This procedure should therefore be considered for patients with appropriate coronary anatomy, in whom cardiopulmonary bypass poses a high risk. This procedure is still hazardous with calcified aorta or emergency operation.
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PMID:Coronary artery bypass without cardiopulmonary bypass: analysis of short-term and mid-term outcome in 220 patients. 747 64

Few data exist regarding functional results and long-term survival after coronary bypass in patients on dialysis. Therefore, a retrospective analysis was performed of 21 consecutive patients with dialysis-dependent renal failure who were undergoing coronary artery bypass grafting. Preoperatively, all but 1 patient had associated comorbid illnesses, 15 patients (71%) had class IV angina, and 16 patients (76%) had either left main or three-vessel disease. There were two perioperative deaths (9%), and complications occurred in 10 of the 21 patients (48%). All 19 hospital survivors showed symptomatic improvement with improved overall functional status (mean Karnofsky score increased from 37% +/- 16% preoperatively to 69% +/- 9% at hospital discharge or death; p < 0.001). Actuarial survival rates were 84% +/- 8% and 45% +/- 13% at 1 and 2 years, respectively. Therefore, coronary bypass grafting may be performed in dialysis patients with increased but acceptable morbidity and mortality, with excellent symptomatic relief, and with improved functional status. However, limited long-term survival suggests that the relative costs and benefits of surgical revascularization need further examination in this patient population.
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PMID:Coronary artery bypass grafting in patients with dialysis-dependent renal failure. 797 44

The objective of this investigation was to assess the acute and long-term outcome after coronary angioplasty in patients undergoing chronic hemodialysis. Previous studies have suggested a high incidence of restenosis after coronary angioplasty performed in patients with renal failure. Medical discharge abstracts for 8342 patients undergoing angioplasty during a 5-year period were searched to identify all coronary angioplasty procedures performed in patients undergoing chronic hemodialysis. Procedural and follow-up coronary angiograms were reviewed in a core angiographic laboratory. Hospital records and office visit notes were obtained to assess acute and long-term outcome. Twenty-one patients undergoing chronic hemodialysis had been treated by coronary angioplasty. The 9 men and 12 women had a mean age of 59 +/- 10 years (range 37 to 78 years) and had been undergoing hemodialysis for 6.2 +/- 6.4 years (range 1 to 19 years). Procedural success was achieved in 12 (57%) of 21 patients. Three (14%) patients died; 4 suffered nonfatal myocardial infarctions (19%); 1 (5%) required emergency bypass surgery; and 1 (5%) had abrupt vessel closure without complications. Of the 15 (71%) patients who were discharged with a patent angioplasty vessel, 4 (27%) died and 9 (60%) had recurrence of angina within 1 year. Of 9 patients with recurrent angina, 7 underwent a second angiography, and all showed evidence of restenosis at the previous angioplasty site. The results of coronary angioplasty in these 21 hemodialysis patients suggest a high rate of acute complications and poor long-term prognosis in this subgroup. Other strategies for revascularization should be considered for these patients.
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PMID:Complications and long-term outcome after percutaneous coronary angioplasty in chronic hemodialysis patients. 803 90

We report a case of hypereosinophilia which was associated with the onset of anginal attacks. A 64-year-old man progressed to end-stage renal failure due to diabetic nephropathy, and was treated with continuous ambulatory peritoneal dialysis (CAPD). He had no past history of angina pectoris nor hypereosinophilia. Three weeks after the initiation of CAPD, the eosinophil count in peripheral blood increased (up to 4093/mm3). Two weeks later, he suffered from an anterior chest pain attack, and angina pectoris was diagnosed. As a result of treatment with isosorbide dinitrate and prednisolone, hypereosinophilia disappeared rapidly and repeated episodes of anginal attacks also disappeared. After an interval of 3 months, however, hypereosinophilia (up to 15190/mm3) and anginal attacks recurred. He underwent coronary angiography, in which no stenotic change was observed. The administration of prednisolone was effective in the treatment of these episodes. Although a close relationship between hypereosinophilia and anginal attack has been reported, it has not been known in CAPD patients as described here. Attention should be paid to these relationships in CAPD patients, because hypereosinophilia is frequently observed in maintenance peritoneal dialysis patients.
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PMID:[A case report of angina pectoris associated with hypereosinophilia in a patient on continuous ambulatory peritoneal dialysis (CAPD)]. 807 28

A random sample of 464 dialysis patients was surveyed between December 1990 and June 1991 to compare methods for determining the relationship between cardiovascular disease (CVD) and mortality. The following three methods were used to identify the prevalence of CVD: standard epidemiologic questionnaires, recall by the patient, and a review of the medical record. The 1-year mortality rate during this prospective study (average follow-up, 17.5 months) was 19%. The measure of prevalent CVD found to be the best predictor of the risk of mortality was the review of the medical record. Specifically, after controlling for the effects on mortality of age, sex, race, cause of renal failure, serum albumin level, and performance status (determined by the Karnofsky score), a patient with a history of angina pectoris documented in the medical record had a relative risk (95% confidence interval) of mortality of 1.8 (1.1 to 2.8), and a patient with peripheral vascular disease recorded in the medical record had a relative risk of 1.6 (1.0 to 2.4). Estimates of CVD obtained from either the questionnaires or patient recall resulted in associations between CVD and mortality that were substantially weaker than those for the medical record. We conclude that at present the medical record is the best source of information for estimating the presence of CVD as a mortality risk factor in dialysis patients. We recommend inclusion of a medical record history of CVD as a mortality case-mix factor when comparing dialysis populations.
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PMID:A prospective comparison of methods for determining if cardiovascular disease is a predictor of mortality in dialysis patients. 812 39

From May 1988 to March 1990, the bovine internal thoracic artery (ITA) graft, 3 mm in diameter, was used for coronary artery bypass grafting in 29 patients with the approval of the Japanese Ministry of Health. Excluding three postoperative deaths and 6 patients who rejected postoperative angiography, 20 patients (13 men and 7 women; mean age, 62 years; range, 37 to 80 years) were followed up angiographically for up to 4 years. Sites of bovine ITA anastomosis were as follows: anterior descending, 4; circumflex, 5; and right coronary artery, 11. The mean bovine ITA graft blood flow measured by electromagnetic flowmeter was 75.2 mL/min (range, 40 to 150 mL/min). During the mean follow-up of 45 months (range, 30 to 52 months), 12 patients underwent postoperative angiography once, 6 patients twice, and 2 patients three times. It revealed 14 of 16 (88%) bovine ITA grafts were patent within 2 postoperative months. Three of 6 (50%) were patent at 3 to 12 months, of which 2 patent grafts required balloon angioplasty for distal anastomotic stenosis. In 7 patients restudied later than 1 year (20, 24, 25, 44, 48, 50, and 52 months), one of seven grafts (14%) was patent. There was stenosis (> or = 50%) at four distal and one proximal bovine ITA anastomotic sites, but no focal stenosis was found in the trunk at any period. There was one late death due to renal failure, one myocardial infarction, and one mild angina due to bovine ITA graft failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bovine internal thoracic artery graft for myocardial revascularization: late results. 814 44

240 patients underwent coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC). Mean grafts per patient was 1.9 (range 1-5). The internal mammary artery (IMA) was used in 210 cases (87%), but in only 53 (22%) were there grafts to the circumflex marginals. Unfavorable results included an operative mortality of 7 cases (2.9%), nonfatal perioperative myocardial infarction (MI) (2.5%), stroke (0.4%), and sternal infection (1.7%). There were 2 deaths among 17 patients (12%) with calcified aorta, and 4 among 40 (10%) who underwent emergency operation. Multivariate analysis showed these 2 risk factors to be the only predictors of early mortality: emergency operation odds ratio 9.8, and calcified aorta odds ratio 8.0. Perioperative risk factors that were not major predictors of early mortality or unfavorable outcome included left ventricular dysfunction (EF < 35%: 52 patients, 22%), congestive heart failure (53, 22%), cardiogenic shock (8, 3%), acute MI (67, 28%), age > 70 years (64, 27%), renal failure (22, 9%), and stroke or carotid disease (12, 5%). Followup ranged from 1-31 months (mean 12). There were 9 late deaths (4 cardiac), and 18 cases (7.5%) of early return of angina. 1-year actuarial survival was 92%; 192 patients (80%) had uneventful outcomes and are doing well. Calcified aorta, nonuse of the IMA, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that CABG without ECC can be performed with relatively low operative mortality, but there seems to be increased risk of early return of angina. It should therefore be considered for those patients with appropriate coronary anatomy in whom ECC poses a very high risk. However, it is still a hazardous procedure when used as as an emergency operation, and for cases with calcified aorta.
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PMID:[Coronary artery bypass without extra corporeal circulation]. 854 46

The need to obviate the risks associated with cardiopulmonary bypass (CPB) in coronary surgery has led to an interest in coronary artery bypass grafting without CPB. From November 1994 to May 1995, 58 patients (49 males and 9 females, mean age 61.8 +/- 9.3 years, range 40-74) were selected for coronary artery bypass grafting without CPB. Three patients had left main stenosis and 6 had left ventricular dysfunction (ejection fraction < 40%). Stable angina was present in 42 patients (27 with low threshold angina) and unstable angina in 16. In 44 patients a routine median sternotomy and in 14 cases a small anterior thoracotomy were performed: in the latter the proximal harvesting of the left internal mammary artery was video-assisted by thoracoscopy. The left internal mammary artery was used in 53 cases; the saphenous vein was used in 36 cases; the radial artery was used in 4 cases; the inferior epigastric artery was used in 2 cases and the right gastroepiploic artery in 1 case. We recorded 1 death (1.7%) and 1 case of postoperative low cardiac output syndrome requiring counterpulsation (1.7%). Perioperative myocardial infarction occurred in 3 cases (5.8%). We did not record noncardiac complications (cerebrovascular, renal failure, prolonged ventilatory support over 24 hours or sternal wound complications). Supraventricular and ventricular arrhythmias were never detected. Mean intensive care unit and hospital stay were 1.1 +/- 0.5 and 5.1 +/- 1.7 days, respectively. In conclusion, according to our experience, "beating heart" coronary surgery is a new promising technique that can be considered alternative in most cases to percutaneous transluminal coronary angio and complementary to conventional coronary surgery.
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PMID:Coronary surgery without cardiopulmonary bypass. 870 63


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