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Coronary artery bypass grafting in patients with dialysis-dependent renal failure
C H Owen1, R G Cummings, T L Sell
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Coronary artery bypass grafting in dialysis patients offers significant symptomatic relief and improved function, despite higher risks. Long-term survival remains limited, warranting further cost-benefit analysis for surgical revascularization.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Limited data exist on functional outcomes and long-term survival after coronary artery bypass grafting (CABG) in patients requiring dialysis.
- Patients with end-stage renal disease often have complex comorbid conditions, increasing surgical risk.
Purpose of the Study:
- To evaluate the functional results and long-term survival after CABG in patients with dialysis-dependent renal failure.
- To assess the morbidity and mortality associated with CABG in this high-risk population.
Main Methods:
- Retrospective analysis of 21 consecutive patients undergoing CABG while on dialysis.
- Assessment of preoperative comorbidities, angina class, and coronary artery disease severity.
- Evaluation of perioperative complications, mortality, functional status (Karnofsky score), and long-term survival.
Main Results:
- High prevalence of severe comorbid illnesses (95%) and advanced coronary artery disease (76% left main or three-vessel disease).
- Perioperative mortality was 9% (2/21 patients), with 48% experiencing complications.
- Hospital survivors showed significant functional improvement (Karnofsky score increased from 37% to 69%, p < 0.001).
- Actuarial survival rates were 84% at 1 year and 45% at 2 years.
Conclusions:
- Coronary artery bypass grafting in dialysis patients is associated with increased but acceptable morbidity and mortality.
- Excellent symptomatic relief and improved functional status are achievable post-CABG.
- Limited long-term survival necessitates further investigation into the cost-effectiveness of surgical revascularization for this cohort.
Abstract:
Few data exist regarding functional results and long-term survival after coronary bypass in patients on dialysis. Therefore, a retrospective analysis was performed of 21 consecutive patients with dialysis-dependent renal failure who were undergoing coronary artery bypass grafting. Preoperatively, all but 1 patient had associated comorbid illnesses, 15 patients (71%) had class IV angina, and 16 patients (76%) had either left main or three-vessel disease. There were two perioperative deaths (9%), and complications occurred in 10 of the 21 patients (48%). All 19 hospital survivors showed symptomatic improvement with improved overall functional status (mean Karnofsky score increased from 37% +/- 16% preoperatively to 69% +/- 9% at hospital discharge or death; p < 0.001). Actuarial survival rates were 84% +/- 8% and 45% +/- 13% at 1 and 2 years, respectively. Therefore, coronary bypass grafting may be performed in dialysis patients with increased but acceptable morbidity and mortality, with excellent symptomatic relief, and with improved functional status. However, limited long-term survival suggests that the relative costs and benefits of surgical revascularization need further examination in this patient population.