Our Summary

This research paper looks at people with severe kidney disease who underwent heart bypass surgery between 2010 and 2017. The researchers compared two different types of heart bypass surgery - one where a heart-lung machine was used during the surgery (ONCAB), and another where the surgery was performed without using this machine (OPCAB). They found that patients who had the surgery with the heart-lung machine (ONCAB) had more complications and higher death rates. These patients also needed more blood transfusions, had more fluid drainage, required more use of a special kind of heart pump, and had to stay longer in the intensive care unit. They also had higher levels of certain chemicals in their blood that can indicate heart damage. The researchers concluded that for patients with severe kidney disease, the type of heart bypass surgery that doesn’t use the heart-lung machine (OPCAB) might lead to better outcomes after surgery.

FAQs

  1. What types of heart bypass surgery were compared in this research?
  2. What were the observed complications and outcomes for patients with severe kidney disease who underwent heart bypass surgery using a heart-lung machine (ONCAB)?
  3. Did the research find that one type of heart bypass surgery was safer or more effective for patients with severe kidney disease?

Doctor’s Tip

A doctor might tell a patient undergoing heart bypass surgery to consider discussing with their surgeon the option of having the surgery performed without the use of a heart-lung machine (OPCAB) if they have severe kidney disease. This approach could potentially lead to better outcomes and lower risks of complications compared to using the heart-lung machine during surgery (ONCAB). It is important for patients to have open and honest conversations with their healthcare team about the best treatment options for their individual situation.

Suitable For

Patients who are typically recommended heart bypass surgery are those with severe coronary artery disease that cannot be effectively managed through other treatments such as medications or lifestyle changes. These patients may have symptoms such as chest pain (angina) that significantly impacts their quality of life, or they may have had a heart attack or be at high risk for one.

In addition, patients with certain risk factors may also be recommended for heart bypass surgery. These risk factors may include:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Smoking
  • Obesity
  • Family history of heart disease

It is important for patients to discuss their individual risk factors and treatment options with their healthcare provider to determine if heart bypass surgery is the best course of action for them.

Timeline

Before heart bypass surgery:

  1. Patient undergoes various tests such as angiography, echocardiogram, and blood tests to determine the extent of blockages in the coronary arteries and overall heart health.
  2. Patient may be prescribed medications to manage symptoms such as chest pain or shortness of breath.
  3. Patient may be advised to make lifestyle changes such as quitting smoking, improving diet, and increasing physical activity.

During heart bypass surgery:

  1. Patient is put under general anesthesia.
  2. Surgeon makes an incision in the chest to access the heart.
  3. Blood flow is rerouted around the blocked or narrowed arteries using veins or arteries from other parts of the body.
  4. In some cases, a heart-lung machine is used to support the patient’s circulation during the surgery.

After heart bypass surgery:

  1. Patient is monitored closely in the intensive care unit for a period of time.
  2. Patient may experience pain, fatigue, and difficulty breathing in the days following surgery.
  3. Patient undergoes cardiac rehabilitation to gradually increase physical activity and improve heart health.
  4. Patient is prescribed medications to prevent blood clots, lower cholesterol, and manage blood pressure.
  5. Patient attends follow-up appointments with their healthcare team to monitor progress and address any complications.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with heart bypass surgery for someone with severe kidney disease?
  2. What are the differences between ONCAB and OPCAB heart bypass surgery, and why might one be more beneficial for someone with severe kidney disease?
  3. How long is the recovery process expected to be for someone with severe kidney disease undergoing heart bypass surgery?
  4. What lifestyle changes or ongoing medical care will be needed after heart bypass surgery for someone with severe kidney disease?
  5. Are there any specific medications or treatments that should be avoided or modified for someone with severe kidney disease undergoing heart bypass surgery?

Reference

Authors: Tanrikulu N, Ozbek B. Journal: Cardiovasc J Afr. 2019 Sep/Oct 23;30(5):275-278. doi: 10.5830/CVJA-2019-023. Epub 2019 May 24. PMID: 31140548