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Coronary artery bypass grafting in dialysis patients
1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamotoshi, Japan.
Insights
Coronary artery bypass grafting in dialysis patients presents challenges due to calcification. Utilizing arterial grafts, particularly in situ, offers a viable solution with acceptable outcomes and long-term survival.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Chronic renal failure (CRF) patients undergoing dialysis face unique challenges during coronary artery bypass grafting (CABG).
- Atherosclerotic complications, including extensive calcification, are prevalent in this population.
Purpose of the Study:
- To analyze the characteristic problems associated with CABG in patients with CRF.
- To evaluate the efficacy and safety of arterial grafts in this high-risk group.
Main Methods:
- Retrospective study of 51 consecutive dialysis patients undergoing isolated CABG over a 9-year period.
- Analysis of operative details, graft types, calcification severity, and perioperative outcomes.
- Assessment of long-term survival and cardiac event-free rates.
Main Results:
- Significant coronary and ascending aorta calcification (mean 4.2 segments) required operative modifications in 16% of patients.
- Arterial grafts were used in 27% of cases, including bilateral internal mammary artery grafts.
- Perioperative mortality was 7.8%, with 16% experiencing non-lethal complications.
- Actuarial survival at 5 years was 71%, with cardiac event-free rates at 65%.
Conclusions:
- Extensive calcification in coronary arteries and the ascending aorta is a significant concern in long-term dialysis patients undergoing CABG.
- Preferential use of in situ arterial grafts can minimize manipulation of the calcified ascending aorta.
- This approach demonstrates acceptable perioperative morbidity and mortality, alongside favorable long-term survival rates.
Background:
To analyze the characteristic problems of coronary artery bypass grafting in patients with chronic renal failure.
Methods:
Fifty-one consecutive dialysis patients who required isolated coronary bypass grafting over a 9-year period were studied retrospectively.
Results:
Nine patients (18%) had emergent operation, 4 of whom had intraaortic balloon counterpulsation instituted preoperatively. A mean of 3.3 +/- 1.0 bypasses per patient were grafted; 14 patients (27%) had bypass with two arterial grafts, 13 (25%) of which used left internal mammary artery and gastroepiploic artery and one of which used bilateral internal mammary artery grafts. A mean of 4.2 +/- 2.6 coronary artery segments were calcific according to American Heart Association classification. Eight patients (16%) required operative modifications to avoid manipulating calcific plaques on the ascending aorta. Four patients (7.8%) died, and 15 had nonlethal complications. The actuarial survival rates in 47 hospital survivors at 1, 3, and 5 years were overall 89%, 84%, and 71%, respectively, and estimates for cardiac deaths 93%, 93%, and 82%, respectively. Cardiac event-free rates after coronary artery bypass grafting were 83% and 65% for 3- and 5-year periods, respectively.
Conclusions:
Calcification of coronary arteries and the ascending aorta is a serious problem in long-term dialysis patients. However using arterial grafts, preferentially, in situ, seems to provide a practical alternative to minimize manipulating the ascending aorta during coronary artery bypass grafting, with acceptable perioperative morbidity and mortality rates and long-term survival.