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Immediate and long-term results of coronary revascularization in patients undergoing chronic hemodialysis
P Castelli1, A M Condemi, M Munari
1Anaesthesia and Intensive Care L. Sacco Hospital, Milan, Italy.
Objective:
To evaluate morbidity and long-term survival in end stage renal disease (ESRD) patients, undergoing coronary artery bypass graft surgery.
Methods:
We identified 22 such patients who underwent bypass grafting between 1987 and 1997. Symptomatic status of angina was rated using the classification of the Canadian Cardiovascular Society (CCS) and the functional status, was assessed using the Karnofsky scoring system. The patients were hemodialyzed the day before surgery and 24-48 h after surgery.
Results:
Two patients operated on for acute myocardial infarction died after 4 days. Follow-up was completed in the remaining 20 patients (the mean follow-up time was 25+/-15 months). The survival rates at 1, 2 and 3 years was 84.5%, 74% and 59%, respectively. The symptoms diminished and the functional status was significantly improved.
Conclusion:
We conclude that elective coronary artery bypass in dialysis patients can be performed with acceptable morbidity and mortality. We advocate early surgical treatment. However, long-term survival is limited and this requires further investigation.