Key result
Ipsilateral ITA CABG and AV shunts link to ~116% higher cardiac event risk versus contralateral.
Why the study?
The impact of coronary steal due to ipsilateral upper extremity AV hemodialysis shunt in patients with ITA CABG on clinical outcomes was uncertain.
Does an ipsilateral location of an arteriovenous hemodialysis shunt compared to a contralateral location increase the risk of cardiac events in chronic hemodialysis patients undergoing CABG with an internal thoracic artery?
Cohort (n=112)
Does an ipsilateral location of an arteriovenous hemodialysis shunt compared to a contralateral location increase the risk of cardiac events in chronic hemodialysis patients undergoing CABG with an internal thoracic artery?
In chronic hemodialysis patients undergoing CABG with an internal thoracic artery, an ipsilateral upper extremity AV shunt is associated with a significantly increased risk of cardiac events compared to a contralateral shunt, likely due to coronary steal.
Answers are grounded in this paper and cite their sources.
Ipsilateral AV shunts may raise cardiac risk after ITA CABG in dialysis patients; leaves open optimal laterality pending prospective trials.
The possibility of developing coronary steal in patients having coronary artery bypass graft (CABG) using internal thoracic artery (ITA) and ipsilateral upper extremity arteriovenous (AV) hemodialysis shunt has been reported. The impact of this phenomenon on clinical outcomes is uncertain. The aim of this study was to investigate an association between the AV dialysis shunt location regarding the side of the ITA CABG and clinical outcomes. This retrospective cohort study included chronic hemodialysis patients having ITA CABG and upper extremity AV shunt. The patients were divided into two groups: those with ipsilateral and those with contralateral location of ITA CABG and AV shunt. The outcomes were: death from any cause, cardiac death and a first cardiac event. In a group of 112 chronic hemodialysis patients having CABG, 32 had an ipsilateral and 25 had a contralateral location of ITA CABG and an upper extremity AV shunt. Significantly more cardiac events occurred in the group with an ipsilateral compared to a contralateral location of ITA CABGs and dialysis AV shunts (hazard ratio, 2.16 [95% CI, 1.11 to 4.19], P = 0.023). There was no difference between the groups in the all cause mortality risk (hazard ratio, 1.005 [95% CI, 0.43 to 2.37], P = 0.990) or the risk of cardiac death (hazard ratio, 2.43 [95% CI, 0.64 to 9.17], P = 0.191). The ipsilateral location of a CABG with the use of ITA and upper extremity AV hemodialysis shunt may be associated with increased risk of cardiac events.
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Feldman et al. (2014) conducted a cohort in Chronic hemodialysis requiring coronary artery bypass graft (n=112). Ipsilateral location of ITA CABG and AV shunt vs. Contralateral location of ITA CABG and AV shunt was evaluated on Cardiac events (HR 2.16, 95% CI 1.11-4.19, p=0.023). Ipsilateral location of ITA CABG and AV hemodialysis shunt increased the risk of cardiac events compared to contralateral location.
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