| [ Summary ] |
Cardiovascular diseases have become more frequent causes in regard to mortality of hemodialysis (HD) patients. Thus, management of ischemic and valvular heart diseases is a very important issue in order to improve the prognosis of HD patients. In HD patients with ischemic heart disease, revascularization of significant coronary artery stenoses may improve the quality of their lives and lengthen them. In patients having triple vessel disease and/or disease of the left main trunk, coronary artery bypass grafting (CABG) is recommended. However, in patients with single and double vessel disease, percutaneous transluminal coronary angioplasty (PTCA) as an alternative to CABG may be chosen for coronary revascularization. According to the data gleaned from the whole American dialysis population, we may see that the event-free survival rate at two years is better in CABG patients than in PTCA patients for the three end-points of actual death, cardiac death, and myocardial infarction or cardiac death, despite an initially higher in-hospital mortality rate for CABG patients. The efficacy of PTCA for patients' prognosis and in improving the quality of patients' lives may not be great enough. Recently, several reports demonstrated that the restenosis rate is relatively lower at the revascularized sites where coronary stents heve been implanted. Coronary stenting may be a promising procedure for HD patients suffering from ischemic heart disease.
Aortic stenosis with calcification in HD patients is also a critical problem. Mechanical valve replacement soon after the appearance of symptoms due to stenosis should improve prognoses in these cases. |