Outcome of coronary artery bypass surgery in diabetic transplant candidates.
Insulin-dependent diabetic (IDDM) patients with end-stage renal disease and coronary artery stenoses > or = 75% have a poor prognosis. However, information is lacking on the morbidity and mortality of the coronary artery bypass operation in this group. We studied 30 consecutive IDDM transplant candidates undergoing a bypass operation to determine the incidence of complications and long-term outcome. Perioperative mortality was 3% and the complication rate was 60%. During follow-up, five patients experienced six myocardial infarctions, the majority within six months of operation. Twenty-one patients underwent successful kidney transplantation after the bypass operation. Overall patient survival was 80%, 73%, and 66% at 1, 2 and 4 yr. In summary, the coronary artery bypass procedure in IDDM transplant candidates has a high morbidity, but the long-term outcome is good. Appropriately counseled IDDM transplant candidates with coronary artery disease should be considered for coronary revascularization and subsequent transplantation.
Manske
C L
CL
Departments of Medicine and Surgery, University of Minnesota School of Medicine, Minneapolis, USA.
Nelluri
S
S
Thomas
W
W
Shumway
S J
SJ
D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors