Coronary artery by pass graft operation in renal transplant recipient
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Coronary Artery by Pass Graft Operation in Renal Transplant Recipient Case Report F. Mitropoulos, M. A. Kanakis, E. Theodoropoulou, N. Dalianis, V. Votteas, J. Boletis, Eu. Yettimis, A. Kostakis Received 09/02/2010 Accepted 05/03/2010
Abstract We describe the case of a man, with a history of a cadaveric renal transplantation two years earlier, who developed symptomatic triple coronary-vessel disease. He underwent a triple coronary artery bypass graft operation and his postoperative course was uneventful. We discuss the distinct problems and operative precautions regarding this particular group of patients.
Keywords
Renal transplantation, Coronary artery bypass graft operation, Perioperative risk
Introduction Coronary artery disease is a common problem among patients with end-stage chronic kidney disease and those with renal transplants. Patients who have undergone renal transplantation are at risk of developing atheromatosis due to arterial hypertension, diabetes mellitus, hypertriglyceridemia, abnormal LDL metabolism and immunosuppressive regimen [1-3], while those who have received a renal graft are prone to developing accelerated atheromatosis [4]. The English literature provides poor data on the risk and mortality of patients with renal transplants who undergo coronary artery bypass graft surgery (CABG). Questions emerge concerning the ability of the renal graft to counter the effects of cardiac surgery and extracorporeal circulation and the extent of risk involved regarding the rejection, infection and wound healing in these patients [3]. We describe the case of a man with a history of cadaveric renal transplantation who displayed symptomatic triple coronary-vessel disease and underwent CABG surgery and we discuss the periop-Paediatric and Congenital Heart Surgery Department, Onassis Cardiac Surgery Centre, Athens-Greece -1st Department of Surgery, General Hospital of Athens “G. Gennimata -Greece -Renal Department, Laiko General Hospital Athens-Greece -Department of Cardiology, Laiko General Hospital-Greece -2nd Department of Surgery, School of Medicine, University of Athens, Laiko General Hospital-Greece e-mail: [email protected]
erative problems of this distinct group of patients.
Case presentation This is a case of a 58-year-old man with a history of smoking, arterial hypertension, hyperlipidaemia and angina on exertion; he was non diabetic and there was a family history of coronary artery disease. He had undergone heterotopic cadaveric renal transplantation two years earlier and was currently under a triple immunosuppression regimen (oral prednisolone 10 mg, cyclosporine 75mg in the morning and 50 mg at night and mycophenolate mofetil 1g twice a day). The cause of his chronic kidney disease was unknown and he had been under chronic periodic hemodialysis for 4 years. His medical history also included tonsillectomy, peritonitis following peritoneal catheter insertion and the formation of an arteriovenous (AV) fistula on his left forehand. A cardiac echo showed an ejection fraction of 50% with
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