J. C. Duque1, C. Cortesi1, A. Dejman3, L. martinez2, r. vazquez-padron2, L. salman4, m. tabbara2 1University Of Miami,Medicine,Miami, FL, USA 2University Of Miami,surgery,Miami, FL, USA 3University Of Miami,Nephrology,Miami, FL, USA 4University Of Miami,Interventional Nephrology,Miami, FL, USA
Introduction:
Cardiac remodeling and left ventricular hypertrophy are relatively common complications seen in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) ranging from 32 to 75% and 27 to 58%, respectively. Arteriovenous fistula (AVF) for hemodialysis has been traditionally implicated as one of the main factors related to cardiovascular stress and subsequent remodeling.
Methods:
We retrospectively reviewed AVF banding procedures performed at University of Miami Hospital /Jackson Memorial Health System between Jan 1st 2009 and Dec 31st 2014. Demographic data, patient´s comorbidities, AVF type and 2D-Echocardiogram done before and after banding with a minimum interval of 6 months from the procedure were analyzed.
Results:
From at total of 74 patients who underwent AVF banding, 24 had 2D-Echocardiogram performed before and after the banding; 33 patients had a 2D-Echocardiogram done before and 38 had it after the procedure. The interval time between the 2 sonograms was 1108.9 (±628) days, 651.8 (±484) days before and 457.0 (±365) days after the surgical banding. The mean age at the time of the procedure was 55 (±12); hypertension was present in 95.8% of the patients, coronary artery disease 41.6% and diabetes mellitus 62.5%. Brachio-basilic AVF was the most common vascular access in 62.55% of the patients, followed by brachio-cephalic in 29.1% and radio-cephalic in 8.3% of the patients. Left ventricular mass calculated by (LVmass(ASE): 0.8 (1.04 ([LVIDD + PWTD + IVSTD] 3 – [LVIDD] 3 ))+ 0,6 g) was 202.8 (±78) before the surgical banding and 216.8 (±82) after the banding with a p value: 0.5591. (Normal LV mass 90 – 117).
Conclusion:
We found statistical significance supporting that patients with ESRD who underwent AVF surgical banding have minimal changes or left ventricular mass restitution after the procedure and likely the hypertrophic changes are related to non-surgical factors.