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Coronary surgery in dialysis-dependent patients with end-stage renal failure with and without extracorporeal

S Tugtekin1, U Kappert, K Jarny

  • 1Cardiac Surgery, Heart Center Dresden, Dresden, Germany. malte8554@yahoo.de

The Thoracic and Cardiovascular Surgeon
|March 23, 2007
PubMed

Insights

Coronary artery bypass grafting (CABG) for dialysis patients with end-stage renal failure (ESRF) has comparable hospital mortality and morbidity whether performed on-pump or off-pump. Midterm cardiac events remain a concern for both surgical approaches in this high-risk group.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Internal Medicine

Background:

  • Coronary artery bypass grafting (CABG) is standard for coronary artery disease (CAD) in dialysis-dependent end-stage renal failure (ESRF) patients.
  • However, CABG in this population is a high-risk procedure with increased mortality and morbidity.
  • Avoiding extracorporeal circulation (ECC) is an attractive alternative for dialysis patients.

Purpose of the Study:

  • To compare the clinical outcomes of CABG with and without ECC in dialysis-dependent ESRF patients.
  • To evaluate hospital mortality, morbidity, and midterm cardiac events between on-pump and off-pump CABG.

Main Methods:

  • Retrospective analysis of 73 dialysis-dependent ESRF patients undergoing isolated CABG.
  • Patients were divided into two groups: on-pump (n=43) and off-pump (n=30).
  • Demographic, preoperative data, hospital outcomes, and midterm follow-up were analyzed.

Main Results:

  • Overall hospital mortality was 4.2% (2 on-pump, 1 off-pump), with no significant difference between groups.
  • Morbidity was comparable between the on-pump and off-pump groups.
  • Midterm follow-up showed higher cardiac mortality in the on-pump group (30.2%) compared to the off-pump group (26.7%).

Conclusions:

  • CABG can be safely performed in dialysis-dependent ESRF patients using either on-pump or off-pump techniques.
  • Both approaches yield good clinical results with low morbidity.
  • Midterm cardiac events remain a significant concern regardless of the surgical strategy.

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