Coronary artery bypass grafting in patients with chronic renal failure: A reappraisal.
OBJECTIVE
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.
Samuels
L E
LE
Hahnemann University Hospital, Philadelphia, PA 19102-1192, USA.
Sharma
S
S
Morris
R J
RJ
Kuretu
M L
ML
Grunewald
K E
KE
Strong
M D
MD
Brockman
S K
SK
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery; D003404:Creatinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy / Q000652:urine; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015143:Philadelphia / Q000453:epidemiology; D011182:Postoperative Care; D006435:Renal Dialysis; D015996:Survival Rate; D016896:Treatment Outcome
D003404:Creatinine