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Coronary artery bypass surgery in patients on maintenance dialysis: long-term survival
J A Opsahl1, D G Husebye, H K Helseth
1Division of Nephrology, Hennepin County Medical Center, Minnesota, Minneapolis 55415.
Insights
Coronary artery bypass grafting (CABG) improves symptoms in end-stage renal disease (ESRD) patients. CABG significantly enhances long-term survival for ESRD patients with severe coronary artery disease compared to dialysis alone.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- End-stage renal disease (ESRD) patients often have coronary artery disease (CAD).
- The long-term survival impact of Coronary Artery Bypass Grafting (CABG) in ESRD patients is not well-established.
- Intractable angina is a common symptom in ESRD patients with CAD.
Purpose of the Study:
- To evaluate the long-term survival outcomes of ESRD patients undergoing CABG.
- To compare survival rates between ESRD patients who underwent CABG and a matched control group on dialysis.
- To assess the impact of CABG on functional status in ESRD patients.
Main Methods:
- Retrospective analysis of 39 ESRD patients (Group 1) who underwent CABG for angina.
- Matched control group (Group 2) of 39 ESRD patients on maintenance dialysis.
- Life-table analysis used to determine survival probability from the time of CABG or equivalent dialysis period.
- Study endpoints included death, withdrawal (transplant, transfer, reoperation), or alive on dialysis; non-cardiac deaths were also analyzed as withdrawals.
Main Results:
- Patients undergoing CABG had severe three-vessel disease and left ventricular dysfunction.
- Operative mortality for CABG was 2.6% with an average of 2.56 vessels bypassed.
- Mean follow-up was 34.9 months for CABG group and 17.2 months for dialysis group.
- Two-year survival was significantly higher in the CABG group (91.7%) compared to the dialysis group (51.4%) (P < 0.05).
- Functional classification improved in most CABG patients.
Conclusions:
- CABG can be performed with acceptable risk in ESRD patients.
- CABG leads to symptomatic improvement in ESRD patients with intractable angina.
- CABG significantly improves long-term survival in ESRD patients with severe CAD compared to continued dialysis.
Abstract:
Coronary artery bypass grafting (CABG) can be performed with acceptable risk and results in symptomatic improvement in patients with end-stage renal disease (ESRD). However, the effect of CABG on long-term survival in these patients is unknown. We retrospectively identified 39 patients (group 1) with ESRD who underwent CABG for intractable angina between January 1975 and February 1987 while on maintenance dialysis. Thirty-nine dialysis patients (group 2) were also retrospectively selected for comparison and matched for age, sex, year of initiation, length of time on dialysis, and presence of diabetes mellitus and atherosclerotic heart disease at initiation of dialysis. Using life-table analysis, survival probability (with 95% confidence limits) was determined from the time of CABG for group 1 or after an equivalent period of time on dialysis for group 2. Two life-table analyses were performed; one with study end-points of death, withdrawal (renal transplantation, transfer to other dialysis facilities, and reoperation), and alive on dialysis; and a second with identical end points except that noncardiac deaths were treated as withdrawals. Coronary arteriography revealed severe three vessel disease, left ventricular dysfunction, and segmental wall motion abnormalities in most patients. A mean (+/- SD) of 2.56 +/- 0.75 vessels were bypassed with an operative mortality (30 days) of 2.6%. Mean follow-up after CABG in group 1 was 34.9 +/- 30.1 months, and in most patients functional classification improved. Mean follow-up for group 2 was 17.2 +/- 15.2 months. Two-year survival was 91.7% in group 1 and 51.4% in group 2 (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)