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Coronary artery bypass grafting in patients with dialysis-dependent renal failure
Y Naruse1, H Makuuchi, T Kobayashi
1Cardiovascular Center, Toranomon Hospital, Tokyo, Japan. naruse-y@ma.kcom.ne.jp
Insights
Coronary artery bypass grafting (CABG) in dialysis patients showed higher in-hospital mortality and lower long-term survival rates. However, CABG can improve functional status for these patients.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- End-stage renal disease (ESRD) patients undergoing coronary artery bypass grafting (CABG) present unique preoperative characteristics.
- Dialysis patients often have higher incidences of comorbidities such as congestive heart failure and diseased aorta.
Purpose of the Study:
- To identify preoperative characteristics of dialysis patients undergoing CABG.
- To determine the early and long-term outcomes of CABG in patients requiring dialysis.
Main Methods:
- Retrospective analysis of 60 dialysis patients who underwent CABG between 1982 and 1999.
- Evaluation of preoperative conditions, in-hospital mortality, and long-term survival and cardiac event-free rates.
Main Results:
- In-hospital mortality was 13%.
- Estimated 5-year and 10-year survival rates were 55.6% and 31.8%, respectively.
- The 5-year cardiac event-free rate (excluding in-hospital mortality) was 62.5%.
Conclusions:
- Early and long-term results of CABG in dialysis patients are inferior compared to non-dialysis patients.
- CABG in dialysis-dependent patients can improve functional status while allowing continuation of dialysis therapy.
Abstract:
This study identified preoperative characteristics of dialysis patients undergoing coronary artery bypass grafting (CABG) and determined the early and long-term results. We retrospectively analyzed the data of 60 patients (mean age 60.8 +/- 7.6 years) with end-stage renal disease who underwent CABG between 1982 and 1999. Seventeen (28%) patients underwent CABG for unstable angina, and 9 (15%) patients required preoperative intraaortic balloon pumping. The incidence of congestive heart failure (18%) and diseased aorta (42%) was higher in the dialysis group. In-hospital mortality in the dialysis group was 13% (8/60). The estimated survival rate at 5 and 10 years in the dialysis patients was 55.6 +/- 8.8% and 31.8 +/- 11.6%, respectively. The cardiac event-free rate, excluding the in-hospital mortality, was 62.5 +/- 9.9% at 5 years. Although the early and long-term results of CABG in dialysis patients were inferior to those of nondialysis patients, CABG in dialysis-dependent patients allows the patients to continue their dialysis therapy and to improve their functional status.