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Published on: October 2, 2020
Factors associated with early mortality in haemodialysis patients undergoing coronary artery bypass surgery
Deniz Çevirme1, Taylan Adademir2, Mehmet Aksüt1
1Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
Insights
Coronary artery bypass grafting (CABG) in end-stage renal disease (ESRD) patients is associated with higher mortality. Advanced age, poor functional capacity, and hypertension predict early surgical death in ESRD patients undergoing CABG.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) poses increased risks for patients with end-stage renal disease (ESRD).
- Understanding early outcomes and mortality factors in ESRD patients undergoing CABG is crucial for improving patient care.
Purpose of the Study:
- To evaluate the early results of CABG in patients with ESRD.
- To identify factors influencing mortality rates in this high-risk population.
Main Methods:
- Retrospective analysis of 84 ESRD patients undergoing CABG between 2006-2012.
- Comparison of peri-operative parameters between patients who died (group 1) and survivors (group 2).
Main Results:
- Higher mean age and EuroSCORE in the mortality group.
- Impaired functional capacity (NYHA classes III-IV) significantly increased mortality risk (OR: 3.333).
- No significant difference in mortality between on-pump and off-pump CABG, but on-pump achieved better revascularization.
Conclusions:
- Advanced age, impaired functional capacity, and pre-operative hypertension are key predictors of early mortality in ESRD patients post-CABG.
- On-pump CABG is recommended to achieve complete revascularization.
Introduction:
Coronary artery bypass grafting (CABG) results in higher morbidity and mortality rates in end-stage renal disease (ESRD) patient populations than in patients with normal renal function. This study aimed to identify the early results of CABG performed on ESRD patients, and the factors that affected the mortality rates of those patients.
Methods:
A retrospective evaluation of our hospital database revealed 84 haemodialysis-receiving patients who underwent CABG during the years 2006 to 2012. Mortality was observed in 21 patients (group 1), and this group was compared with the remaining patients (group 2) for peri-operative parameters such as age, EuroSCORE, functional capacity, myocardial infarction, use of inotropes and completeness of revascularisation.
Results:
The study included 60 male (71.4%) and 24 female patients (28.6%); the participants' mean age was 59.50 ± 9.93 years. The pre-operative additive EuroSCORE was 7.96 ± 2.88 (range: 2-18). Pre-operative functional capacity was impaired in 35.7% of the patients [New York Heart Association (NYHA) classes III-IV]. Mean age and preoperative EuroSCORE values of group 1 were significantly higher than those of group 2. Impaired functional capacity (NHYA classes III-IV) was also associated with mortality (OR: 3.333; 95% CI: 1.199-9.268). Fifty-four patients (64.3%) underwent on-pump CABG procedures, and 30 (35.7%) underwent off-pump CABG procedures. The study found no statistically significant difference in mortality rates between these two techniques. Mortality occurred in 12 patients (22.2%) in the on-pump group and in nine (30%) in the off-pump group. Complete revascularisation was performed on 46 patients (85.2%) in the on-pump group and seven (23.3%) in the off-pump group (p < 0.001).
Conclusion:
Advanced age, impaired NYHA functional capacity and pre-operative hypertension were determinative for early-term surgical mortality. An on-pump surgical technique is recommended to ensure completeness of revascularisation.
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