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Outcome of off-pump coronary artery bypass in renal dialysis patients

J-F Liu1, C-H Lin, C-H Chua

  • 1Cardiology, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan - Republic of China.

The Thoracic and Cardiovascular Surgeon
|September 24, 2008
PubMed

Insights

Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) in renal dialysis patients showed acceptable surgical risk but uncertain long-term survival, impacted by non-cardiac deaths. Intensive care for dialysis complications is crucial for improving outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Critical Care Medicine

Background:

  • Renal dialysis patients face significant operative risks during coronary artery bypass grafting (CABG).
  • While CABG without cardiopulmonary bypass (CPB) reduces surgical risk, long-term survival data for this high-risk group remain limited.
  • This study investigates the long-term outcomes of CABG performed without CPB in patients requiring renal dialysis.

Purpose of the Study:

  • To evaluate the long-term survival and outcomes of renal dialysis patients undergoing CABG without CPB.
  • To identify factors influencing survival in this specific patient cohort.
  • To assess the feasibility and efficacy of minimally invasive direct coronary artery bypass (MIDCAB) and off-pump CABG (OPCAB) in this population.

Main Methods:

  • A cohort of 44 renal dialysis patients underwent elective CABG without CPB between 1998 and 2002.
  • Procedures included 17 MIDCAB and 27 OPCAB operations, primarily utilizing left internal thoracic artery (LITA) to left anterior descending (LAD) grafting.
  • Patients had varying degrees of coronary artery disease, with grafts also including saphenous vein grafts to non-LAD coronaries.

Main Results:

  • Follow-up averaged 44.4 months for all 44 patients.
  • Early surgical mortality (within 30 days) was 6.8%, with 25 late mortalities occurring over the follow-up period.
  • The 5-year cumulative survival rate was 38.2%, and freedom from cardiac death was 70.9%. Old age and incomplete revascularization were significant predictors of mortality.

Conclusions:

  • CABG without CPB offers acceptable surgical mortality and morbidity in renal dialysis patients.
  • High rates of non-cardiac death, often linked to dialysis complications, adversely affect overall long-term survival.
  • Combining LITA bypass techniques with intensive management of dialysis complications may improve both short- and long-term results for this patient subgroup.
Abstract

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