TAILIEUCHUNG - Cardiac Surgery in Chronic Renal Failure - part 8

và đặt stent, tương ứng. Sau khi điều chỉnh comorbidities, nguy cơ tương đối (RR) cho CABG là 0,80 cho tất cả các nguyên nhân cái chết và 0,72 cho tử do tim. Tuy nhiên, một lần nữa, bệnh nhân thuật có một tỷ lệ tử vong trong bệnh viện cao hơn so với PTCA | Coronary artery bypass grafting in dialysis-dependent renal failure patients 67 survival was and after CABG PTCA and stenting respectively. After adjusting for comorbidities the relative risk RR for CABG was for all-cause death and for cardiac death. However once again the CABG patients had a higher in-hospital mortality than did the PTCA and stent patients vs and 9 . In the largest single-institution analysis Agirbasli et al. 8 report their 10year experience with CABG and PTCA in DDRF patients. Again higher inhospital mortality was observed for CABG patients than for PTCA patients . In this study however there was no significant difference in 1-year mortality for CABG and PTCA 27 and 25 . PTCA was performed more often in patients with early CAD but CABG was usually performed in patients with more advanced disease . 3-vessel or left main disease thus selection bias may have affected the results. There was also significant interaction between the type of revascularization and the number of diseased vessels. PTCA was associated with a lower mortality in patients with 2-vessel disease and a higher mortality in those with left main disease which suggests that PTCA may be an appropriate treatment for a select group of DDRF patients. However the need for repeat revascularization . PTCA was also significantly higher in the PTCA group 16 than in the CABG group . After 1 year of the PTCA patients had to undergo CABG while none of the CABG patients had to undergo a repeat CABG procedure 8 . Such studies demonstrate an overall survival advantage for DDRF patients who undergo CABG. However treatment may be influenced by preoperative comorbid conditions such as severity of CAD and degree of left ventricular dysfunction 11 . In a retrospective study comparing 59 600 patients undergoing isolated CABG or PCI Szczech et al. 11 investigated comparative survival while controlling for confounding factors including severity of

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