| Theme |
Diagnosis and treatment for coronary artery disease and valvular heart disease in dialysis patients |
| Title |
Indications for and timing of coronary artery bypass grafting in chronic hemodialysis patients |
| Author |
Naoki Washiyama |
First Department of Surgery, Hamamatsu University School of Medicine |
| Author |
Norihiko Shiiya |
First Department of Surgery, Hamamatsu University School of Medicine |
| [ Summary ] |
Coronary artery disease in patients requiring hemodialysis is characterized by the prevalence of multi-vessel involvment, multiple lesions and severe calcification. Because the risk of cardiac surgery in patients on chronic hemodialysis is relatively high, percutaneous coronary interventions (PCI) are increasingly selected as a method to achieve revascularization. However, even in patients receiving hemodialysis, long-term outcomes are better after CABG than after conservative management or PCI. This is true even in the era of drug eluting stents. Treatment strategies should be individualized by teams composed of surgeons, cardiologists and nephrologists, according to the patients' comorbidities and prognoses without overestimating the surgical risks. |