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Long-term survival after coronary arterial grafts in patients with end-stage renal disease

Taro Nakatsu1, Nobushige Tamura, Yutaka Sakakibara

  • 1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto City, Japan. nakatsu-taro@hotmail.co.jp

The Annals of Thoracic Surgery
|August 25, 2010
PubMed

Insights

Bilateral internal thoracic artery (BITA) grafting in end-stage renal disease (ESRD) patients undergoing coronary artery bypass grafting (CABG) showed no significant long-term survival benefit. However, BITA grafting may improve outcomes for ESRD patients without diabetes.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Transplantation

Background:

  • Bilateral internal thoracic artery (BITA) grafting is established to enhance long-term survival in coronary artery bypass grafting (CABG).
  • Limited data exists on BITA grafting efficacy in end-stage renal disease (ESRD) patients.
  • This study evaluates the potential benefits of BITA grafting specifically in the ESRD population.

Purpose of the Study:

  • To investigate the long-term outcomes of BITA grafting compared to single internal thoracic artery (SITA) grafting in ESRD patients.
  • To assess the impact of BITA grafting on survival rates, cardiac death, and cardiac events in this patient group.

Main Methods:

  • A retrospective analysis of 130 ESRD patients on chronic hemodialysis who underwent isolated CABG between 1988 and 2009.
  • Comparison of outcomes between 49 patients receiving BITA grafts and 81 patients receiving SITA grafts.
  • Mean follow-up duration of 5.2 ± 3.8 years.

Main Results:

  • No significant difference in mortality rates between BITA (4.1%) and SITA (4.9%) groups (p = 0.8215).
  • Similar incidences of mediastinitis and re-thoracotomy for bleeding were observed in both groups.
  • While long-term survival rates showed no statistical difference (p = 0.1636), BITA grafting demonstrated improved cardiac event outcomes in ESRD patients without diabetes (p = 0.0143).

Conclusions:

  • Coronary artery bypass grafting with BITA grafts does not offer significant long-term survival advantages for ESRD patients.
  • BITA grafting may be associated with improved long-term cardiac event outcomes in ESRD patients who do not have diabetes mellitus.
Abstract

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