Coronary artery bypass grafting in patients with dialysis-dependent renal failure.

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.

Duke Scholars

Author Donald D. Glower Jr. Surgery, Cardiovascular and Thoracic Surgery