Coronary artery bypass surgery in patients on chronic hemodialysis. A case-control study.
OBJECTIVE
To determine the morbidity and mortality of cardiac catheterization and coronary artery bypass surgery in patients on chronic hemodialysis.


METHODS
Retrospective case-control study.


METHODS
A referral-based university hospital.


METHODS
Sixteen consecutive patients on chronic hemodialysis who had catheterization and bypass surgery: 30 controls matched for age, sex, year of operation, severity of coronary disease, left ventricular function, hypertension, diabetes, and urgency of surgery: and 34 consecutive controls having bypass surgery.


RESULTS
No major complications of catheterization occurred. Of 16 patients on dialysis, 7 had urgent surgery within 24 hours of catheterization. One patient on dialysis and 3 consecutive controls died, but none of the matched controls died. Postoperative morbidity was increased in the hemodialysis group as measured by the duration of mechanical ventilation (4.7 +/- 2.3 compared with 1.5 +/- 0.8 days in matched controls [mean +/- SE]), the duration of hemodynamic support (4.2 +/- 2.3 compared with 0.8 +/- 0.2 days), the length of stay in the intensive care unit (6.4 +/- 2.4 compared with 2.8 +/- 0.9 days), and the length of postoperative stay in the hospital (15.4 +/- 2.1 compared with 10.8 +/- 1.1 days) (all P less than 0.05). Four intraoperative myocardial infarctions occurred in patients on dialysis compared with two patients in the case-matched controls. Differences in morbidity between the two control groups were not significant.


CONCLUSIONS
Morbidity is increased in patients on hemodialysis having coronary artery bypass surgery compared with controls matched for severity of coronary disease; however, the outcome in all but one patient on dialysis was good. Bypass surgery is an acceptable treatment for patients on dialysis with advanced coronary artery disease. Because urgent surgery is often needed in these patients, earlier evaluation of the need for revascularization may improve clinical results.
Hospital of the University of Pennsylvania, Philadelphia.
E
E
Deutsch
R C
RC
Bernstein
P
P
Addonizio
W G
WG
Kussmaul
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D006435:Renal Dialysis / Q000009:adverse effects; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012306:Risk