Myocardial revascularization in patients with chronic renal failure

Symptomatic coronary artery disease in patients with chronic renal failure can complicate their management in a dialysis program. Hypotension associated with hemodialysis and the anemia of chronic renal disease can produce anginal episodes refractory to medical management. Untreated coronary artery disease may be a contraindication to renal transplantation in an otherwise acceptable candidate. We have encountered three cases of coronary artery disease severe enough to necessitate coronary bypass in patients from our long-term hemodialysis program. All three patients had uncomplicated postoperative courses, none had perioperative infarction, and in all three patients postoperative angiography demonstrated patency of all grafts. One patient subsequently underwent successful renal transplantation; the other two patients have continued in hemodialyses since bypass. We believe our experience and the reported experience of others confirm the feasibility of coronary bypass grafting in patients with chronic renal failure.