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Ann Thorac Surg 2002;73:350
© 2002 The Society of Thoracic Surgeons

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Correspondence

Is "steal" present in hemodialysis patients with ipsilateral internal mammary graft?: Reply

^a Department of Cardiovascular Surgery, Kumamoto Central Hospital, 1-5-1 Tainoshima, Kumamoto-shi, Japan

To the Editor

We thank Drs Baciewicz and Harris for their interest in and comments regarding our article. We monitored 77 dialysis patients who had undergone coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). The left ITA was used in 52 patients and the bilateral ITA was used in 25 [1]. Of these patients, 74 were on maintenance hemodialysis. In 64 patients, we used the ipsilateral ITA for hemodialysis access in the upper arm (the left ITA in 54 patients, the right ITA in 10). The contralateral ITA was used in 10 patients. None of these 74 patients experienced angina during early postoperative hemodialysis; however, lethal arrhythmia (ventricular fibrillation) occurred in 2 individuals. The ipsilateral ITA, left ITA, and left upper arm had been used in 1 patient, and the contralateral ITA in the other. The cause of lethal arrhythmia in the ipsilateral ITA patient was assumed to be digoxin poisoning, because the serum level was very high. No coronary ischemia attributable to steal during hemodialysis was observed in any of our patients.

The coronary region of dialysis patients is generally calcified and diffuse, and shows poor drainage. This results in unfavorable conditions for a coronary anastomosis and poor long-term patency. The ascending aorta is also often subject to severe atherosclerotic changes [2]. Due to these conditions, the use of in situ arterial grafts, especially the ITA, is recommended. The long-term results [3] suggest that using multiarterial grafts dramatically improves actuarial survival and freedom from cardiac death and cardiac events. In addition, no steal phenomena were observed in any of the patients during either the acute or late phases. We believe that the ITA should be used whenever possible to safeguard against the coronary steal syndrome during hemodialysis.

References

1. Nakayama Y., Sakata R., Ura M. Bilateral internal thoracic artery use for dialysis patients: does it increase operative risk?. Ann Thorac Surg 2001;71:783-787.[Abstract/Free Full Text]
2. Nakayama Y., Sakata R., Ura M., Miyamoto T.A. Coronary artery bypass grafting in dialysis patients. Ann Thorac Surg 1999;68:1257-1261.[Abstract/Free Full Text]
3. Nakayama Y., Sakata R., Ura M. Coronary artery bypass grafting for dialysis patients: usefulness of multiarterial bypass. Artif Organs 2001;25:248-251.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ryuzo Sakata Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nakayama, Y. Articles by Sakata, R. Search for Related Content PubMed Articles by Nakayama, Y. Articles by Sakata, R. Related Collections Coronary disease Related Article