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Coronary Artery Bypass Graft Patency and Survival in Patients on Dialysis
Shirin Siddiqi1, Kirthi Ravichandren1, Edward G Soltesz1
1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
Graft patency for patients on dialysis undergoing coronary artery bypass grafting (CABG) is suboptimal. Saphenous vein graft (SVG) patency was significantly lower than in the general population, potentially impacting outcomes.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Biology
Background:
- Graft patency after coronary artery bypass grafting (CABG) in patients on dialysis remains poorly understood.
- This study investigates the patency of internal thoracic artery (ITA) grafts and saphenous vein grafts (SVGs) in dialysis patients.
Purpose of the Study:
- To assess the patency rates of ITA and SVG grafts in patients undergoing CABG while on dialysis.
- To compare graft patency in this cohort to established data from the general CABG population.
Main Methods:
- Retrospective analysis of 500 dialysis patients who underwent primary CABG between 1997 and 2018.
- Postoperative angiograms of 40 patients with recurrent ischemic symptoms were analyzed for graft stenosis and occlusion.
- Evaluated 36 ITA grafts and 65 SVGs for patency.
Main Results:
- Saphenous vein graft (SVG) patency was 52% at 1 year and 37% at 2 years.
- Internal thoracic artery (ITA) graft occlusion data was limited due to small sample size (3 occlusions out of 36 grafts).
- Technical challenges were noted in 30% of cases due to severe atherosclerotic disease and calcification.
Conclusions:
- Saphenous vein graft (SVG) patency in dialysis patients undergoing CABG is lower than previously reported in non-dialysis populations.
- Suboptimal SVG patency may contribute to the poorer prognosis observed in this patient group.
- Further research is required to optimize graft selection and improve long-term graft patency in dialysis patients.
Background:
Little is known about graft patency after coronary artery bypass grafting (CABG) performed in patients on dialysis. Our aim was to assess patency of internal thoracic artery (ITA) grafts and saphenous vein grafts (SVGs) in these patients.
Methods:
From 1/1997 to 1/2018, 500 patients on dialysis underwent primary CABG with or without concomitant procedures at Cleveland Clinic, 40 of whom had 48 postoperative angiograms for recurrent ischemic symptoms. Complete follow-up was obtained on all but 1 patient lost to follow-up 1 y after CABG. Thirty-six ITA grafts and 65 SVGs were evaluable for stenosis and occlusion.
Results:
Two of 40 patients (5%) had emergency CABG; 3 (7.5%) with calcified aortas had a change in operative strategy to avoid ascending aortic manipulation, 2 (5%) had poor conduit quality, and 12 (30%) had severe diffuse atherosclerotic disease with calcification of the coronary targets causing technical difficulties. Thirty-three patients (82%) were bypassed with an in situ ITA and 3 (7.5%) had a free ITA graft. Three of 36 ITA grafts were occluded at 0.78, 1.8, and 9.4 y (too few to model). SVG patency was 52% and 37% at 1 and 2 y, respectively.
Conclusions:
Among patients on dialysis who underwent CABG, coronary angiography for ischemic symptoms in a select subset revealed that SVG patency was lower than expected from published reports in the general CABG population and may contribute to the poor prognosis of this cohort. Further work is needed to guide graft selection and improve graft patency in dialysis patients.
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