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Coronary artery bypass grafting in patients with chronic renal failure: A reappraisal
L E Samuels1, S Sharma, R J Morris
1Hahnemann University Hospital, Philadelphia, PA 19102-1192, USA.
Insights
Patients with chronic renal failure (CRF) undergoing coronary artery bypass grafting (CABG) face significantly higher mortality and morbidity risks. Long-term survival for these high-risk cardiac surgery patients is substantially lower than for those without CRF.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Chronic renal failure (CRF) is a known risk factor for increased morbidity and mortality in patients undergoing cardiac operations.
- The efficacy and safety of coronary artery bypass grafting (CABG) in patients with CRF remain a subject of debate.
Purpose of the Study:
- To evaluate the outcomes of CABG in patients with chronic renal failure.
- To compare the risks and survival rates of CRF patients undergoing CABG with a control group.
Main Methods:
- Analysis of 44 patients with CRF who underwent CABG, divided into two groups: end-stage renal disease on hemodialysis (Group I, n=13) and pre-dialysis CRF (Group II, n=31).
- Comparison with a control group of 547 patients without CRF undergoing CABG.
- Assessment of hospital mortality, major morbidity, need for postoperative dialysis, length of stay, and long-term survival.
Main Results:
- Hospital mortality was 23% for CRF patients (31% in Group I, 19% in Group II) compared to 5% in the control group.
- Major morbidity occurred in 80% of CRF patients, with 26% requiring permanent postoperative dialysis in Group II.
- Long-term follow-up revealed a total mortality of 57% at over 6 years for CRF patients, significantly higher than their non-CRF counterparts.
Conclusions:
- Patients with CRF undergoing CABG represent an exceptionally high-risk group for mortality and morbidity.
- CRF patients with creatinine levels of 2.5 gm/dL not on dialysis have a high likelihood of requiring permanent postoperative dialysis.
- Long-term survival for cardiac surgery patients with CRF is considerably lower than for those without renal impairment.
Background And Aims:
Chronic renal failure (CRF) is known to increase the morbidity and mortality in patients undergoing cardiac operations. Successful outcome of coronary artery bypass grafting (CABG) in some patients with CRF has been reported, but remains controversial.
Methods:
Forty-four patients with CRF who underwent CABG were examined. Two groups were analyzed. Group I consisted of 13 patients with end-stage renal disease on hemodialysis. Group II consisted of 31 patients with a creatinine > or = 1.6 gm/dL for a minimum of 6 months, but were not on dialysis. There were 36 male and 8 female patients, with a mean age of 71 years.
Results:
The hospital mortality was 10 patients (23%) with 4 (31%) hospital deaths in Group I, and 6 (19%) in Group II. There was major morbidity in 35 (80%) patients. In Group II there were 8 (26%) patients who required permanent postoperative dialysis. A control group of 547 patients 70 years of age who underwent CABG had 30 hospital mortalities (5%) and 75 morbidities (13%). The average length of stay was 27 days. Fifteen patients died at a mean of 34 months after being discharged from the hospital. Nineteen of the original 44 patients remain alive at a mean of 32 months. The total mortality at 6 years and 4 months was 57%.
Conclusions:
Older and sicker patients with CRF who undergo CABG are at an exceptionally high risk for mortality and morbidity. For CRF patients not on dialysis with a creatinine 2.5 gm/dL, there is a strong likelihood of permanent postoperative dialysis. Long-term follow-up shows survival to be well below their non-CRF counterparts.