tailieunhanh - Cardiac Surgery in Chronic Renal Failure - part 5

xuất hiện một nghiên cứu thuần tập hồi cứu 13 bệnh nhân lọc máu trải qua PTCA 13 điều khiển. Sau 2 năm, 50% của nhóm lọc máu có kinh nghiệm một sự kiện tim mạch (đau thắt ngực tái phát, MI, tử vong tim mạch, hoặc CAB) so với 15% của các điều khiển. Kahn và cộng sự. | Percutaneous coronary revascularization in patients with ESRD 33 Reusser et al. 59 matched a retrospective cohort of 13 dialysis patients undergoing PTCA to 13 controls. At 2 years 50 of the dialysis group experienced a cardiac event angina recurrence MI cardiac death or CAB versus 15 of the controls. Kahn et al. s 48 paper is of historical interest as it was the first widely read publication to highlight unfavorable PCI outcomes in dialysis patients the first publication was probably Kober et al. published in German 60 . They reported a series of 17 chronic dialysis patients with 47 of 49 vessels successfully dilated. The in-hospital mortality was and at 20-month follow-up the mortality was 53 . In the 15 patients discharged alive during a mean follow-up of 20 months seven more patients died with total mortality of 53 . Of the 15 patients discharged alive after PTCA angina recurred in 12 of 15 patients. In 26 of 32 81 dilated vessels restenosis was demonstrated angiographically. Ohmoto 43 reported the outcome of 92 dialysis patients receiving PTCA and 47 undergoing CAB surgery in a retrospective series of patients treated in 1983-1997. PTCA alone was used in 76 of patients with stents in 17 . PCI was initially successful in 87 of patients. Restenosis was present in 40 of 68 59 patients having repeat angiography and the authors implied that routine angiography was performed at 3-6 months post-PCI but it is unclear what happened to the other PCI patients in the first 6 months of follow-up . The in-hospital death for PTCA was 1 for PTCA versus 15 for CAB. The long-term survival however was similar to 5-year 57 survival after PCI and 62 after CAB and considerably better than other reported series . Compete revascularization by either method was associated with better outcome. On long-term follow-up in the PCI group 39 patients had a second PTCA and 19 underwent CAB 38-month follow-up and 12 patients had PTCA and 3 repeat CAB in the CAB group 51-month follow-up .