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Published on: July 3, 2013
Coronary-artery surgery in patients with end-stage renal disease
Insights
Patients with end-stage renal failure and ischemic heart disease can undergo coronary artery bypass surgery with acceptable risk. Pre- and post-operative dialysis improves outcomes by managing fluid overload and hyperkalemia, relieving angina, and enhancing activity levels.
Area of Science:
- Cardiology
- Nephrology
Background:
- End-stage renal failure (ESRF) often coexists with severe ischemic heart disease (IHD).
- Management of IHD in ESRF patients presents unique challenges due to comorbidities and procedural risks.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting (CABG) in patients with ESRF and IHD.
- To assess the impact of CABG on angina symptoms and functional status in this patient population.
Main Methods:
- Coronary arteriography was performed on 15 patients with ESRF and IHD between 1975 and 1979.
- Ten patients underwent CABG, with two also receiving mitral valve replacement.
- Perioperative dialysis was utilized to manage fluid balance and electrolyte abnormalities.
Main Results:
- One patient died post-angiography due to pump failure; one diabetic patient died post-surgery from sepsis.
- Eight of the nine surviving patients experienced marked improvement in symptoms and activity levels.
- Surgical intervention effectively relieved angina and improved functional capacity in most survivors.
Conclusions:
- Coronary artery bypass surgery is feasible in selected ESRF patients with IHD, carrying increased but acceptable risks.
- Perioperative dialysis is crucial for managing extracellular volume and hyperkalemia, optimizing surgical outcomes.
- While CABG improves angina and activity levels, its impact on long-term survival in ESRF patients remains uncertain.
Abstract:
Between 1975 and 1979 we performed coronary arteriography on 15 patients with end-stage renal failure and clinical evidence of severe ischemic heart disease. One patient died after the procedure of severe pump failure. Ten patients subsequently received coronary-artery bypass grafts, and two of these patients also received mitral-valve replacement. One patient, a diabetic, died of sepsis after surgery. Eight of the nine surviving patients, including the two patients who had undergone mitral-valve replacement, are markedly improved as a result of surgery. Our experience indicates that these patients can undergo angiography and coronary-artery bypass surgery at an increased but acceptable risk, provided dialysis is done before and after cardiac catheterization and surgery to control extracellular volume overload and hyperkalemia. The operation benefits patients with end-stage renal failure and severe ischemic heart disease by relieving angina and improving their level of activity. It is unclear whether survival is improved for these patients.
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