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Coronary artery bypass graft surgery in dialysis patients
M Jahangiri1, J Wright, S Edmondson
1Department of Cardiac Surgery, London Chest Hospital, UK.
Insights
Coronary artery bypass graft surgery in chronic dialysis patients shows acceptable short-term outcomes and improved function, but long-term survival remains limited, warranting further study.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Patients on long-term dialysis often present with advanced coronary artery disease.
- Coronary artery bypass graft (CABG) surgery in this population poses unique challenges due to comorbidities.
Purpose of the Study:
- To evaluate the short-term results and long-term survival of patients on chronic dialysis undergoing CABG surgery.
- To assess the impact of CABG on functional status in dialysis patients.
Main Methods:
- Retrospective analysis of 19 patients on established dialysis who underwent coronary revascularization between 1983 and 1995.
- Assessment of preoperative angina severity and postoperative outcomes including mortality and functional status.
Main Results:
- The 30-day mortality rate was 5%.
- Actuarial survival at one, two, and three years was 87%, 78%, and 59%, respectively.
- Significant improvement in functional status was observed, with a mean Karnofsky score of 76% at three years.
Conclusions:
- CABG surgery in chronic dialysis patients is associated with increased but acceptable morbidity and mortality.
- The procedure leads to considerable symptomatic and functional improvement.
- Long-term survival remains a concern and requires further investigation.
Objective:
To examine the short term results and long term survival of patients on long term dialysis undergoing coronary artery bypass graft surgery.
Methods:
A retrospective analysis of 19 patients on established dialysis who underwent coronary revascularisation between 1983 and 1995; 14 patients (73%) had class IV angina and five (25%) had unstable angina requiring heparin and nitrate infusions before surgery.
Results:
The 30 day mortality was 5%. Follow up was completed in the remaining 18 patients. The mean follow up time was 34 months (range eight to 61). During the follow up period four patients died of cardiac causes. The actuarial survival at one, two, and three years was 87%, 78%, and 59%, respectively. The overall functional status was significantly improved compared to preoperative levels, with a mean Karnofsky score of 76% (p < 0.01) at three years.
Conclusions:
Coronary artery bypass graft surgery can be performed with increased but acceptable morbidity and mortality in chronic dialysis patients. It results in considerable improvement in symptoms and functional status. However, long term survival is limited and this requires further investigation.