Coronary artery bypass grafting in dialysis patients

Cardiac disease continues to be a major cause of death in patients undergoing long-term hemodialysis. The results of coronary artery bypass grafting (CABG) for severe coronary artery disease in long-term hemodialysis patients have been studied in a group of 12 patients who underwent CABG between January 1979 and December 1983. Hospital mortality was 8% (1 of 12 patients). This patient died of ventricular arrhythmia. Two late deaths occurred, 1 from peritonitis in a patient undergoing long-term peritoneal hemodialysis and 1 from metastatic renal cell carcinoma. The two postoperative complications (morbidity 17%) consisted of a sternal dehiscence secondary to mediastinitis and a perioperative cerebrovascular accident. Ten of the 11 hospital survivors experienced complete relief from angina. In the other patient the angina became easier to control with medication. Combining this series of patients with those previously reported in the literature allows determination of actuarial survival in a group of 25 patients followed up for 1 to 79 months (mean, 33 months). Actuarial survival was 83% at one year, 69% at three years, and 48% at five years. This is not significantly different from the survival of long-term hemodialysis patients who have coronary disease but have not undergone CABG. It appears that CABG, when performed in long-term hemodialysis patients, is associated with an only slightly greater risk of mortality and morbidity than CABG performed in routine patients. Although CABG provides considerable symptomatic relief of angina, no statistically significant change in actuarial survival can be demonstrated.