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[Results of coronary artery bypass grafting in dialysis patients]
J Kobayashi1, Y Sasako, Y Kosakai
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Insights
Coronary artery bypass grafting (CABG) in dialysis patients showed a 14% hospital mortality and 29% morbidity. Survival rates were 86% at 1-3 years, suggesting potential benefits over non-CABG treatment for these patients.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Dialysis patients with coronary artery disease (CAD) present unique challenges for surgical intervention.
- Coronary artery bypass grafting (CABG) outcomes in this high-risk population require careful evaluation.
Purpose of the Study:
- To assess the short- and medium-term results of CABG in patients with chronic renal failure undergoing dialysis.
- To compare survival rates with historical data for dialysis patients with CAD.
Main Methods:
- Retrospective analysis of 14 dialysis patients who underwent CABG between May 1990 and October 1994.
- Inclusion of patients with concomitant valve repair.
- Evaluation of hospital mortality, postoperative complications, graft patency, and actuarial survival.
Main Results:
- Hospital mortality was 14% (2/14), with deaths due to ileus and agranulocytosis.
- Postoperative complications (morbidity 29%) included sternal dehiscence, cardiac tamponade, and perioperative myocardial infarction.
- Graft patency was high (97% at 1 month), with actuarial survival of 86% at 1-3 years and 43% at 3.5 years.
Conclusions:
- CABG in dialysis patients yields acceptable short- and medium-term results, with survival potentially better than non-CABG treated CAD dialysis patients.
- Larger left ventricular size correlated with poorer outcomes.
- Factors like cardiopulmonary bypass time and transfusion volume may influence mortality and morbidity.
Abstract:
To determine the short- and medium-term results of coronary artery bypass grafting (CABG) in dialysis patients, we analyzed a group of 14 patients with chronic renal failure who underwent CABG between May 1990 and October 1994. Two patients had concomitant valve repair for mitral regurgitation. Hospital mortality was 14% (2 out of 14). These two patients died of ileus due to ischemic colitis and agranulocytosis respectively. There was one late death from stroke. The four significant postoperative complications (morbidity 29%) were composed of two sternal dehiscence, one cardiac tamponade because of bleeding, and one perioperative myocardial infarction. Graft patency rate was 97% (34 out of 35 in 13 patients) within one month. Actuarial survival was 86% at one 1 to 3 years, and 43% at 3 and a half years. This rate is not significantly different from all dialysis patients, but night be better than dialysis patients with coronary artery disease who had not undergone CABG in the previous reports. Left ventricular size is larger in patients who died or who had significant complications in hospital than in patients with uneventful postoperative course. Cardiac arrest time, cardiopulmonary bypass time, chest tube output, and the amount of transfusion might be also related to mortality and morbidity though statistically not significant.