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.
Owen
C H
CH
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Cummings
R G
RG
Sell
T L
TL
Schwab
S J
SJ
Jones
R H
RH
Glower
D D
DD
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis