Coronary artery bypass grafting in dialysis patients.
BACKGROUND
To analyze the characteristic problems of coronary artery bypass grafting in patients with chronic renal failure.


METHODS
Fifty-one consecutive dialysis patients who required isolated coronary bypass grafting over a 9-year period were studied retrospectively.


RESULTS
Nine patients (18%) had emergent operation, 4 of whom had intraaortic balloon counterpulsation instituted preoperatively. A mean of 3.3 +/- 1.0 bypasses per patient were grafted; 14 patients (27%) had bypass with two arterial grafts, 13 (25%) of which used left internal mammary artery and gastroepiploic artery and one of which used bilateral internal mammary artery grafts. A mean of 4.2 +/- 2.6 coronary artery segments were calcific according to American Heart Association classification. Eight patients (16%) required operative modifications to avoid manipulating calcific plaques on the ascending aorta. Four patients (7.8%) died, and 15 had nonlethal complications. The actuarial survival rates in 47 hospital survivors at 1, 3, and 5 years were overall 89%, 84%, and 71%, respectively, and estimates for cardiac deaths 93%, 93%, and 82%, respectively. Cardiac event-free rates after coronary artery bypass grafting were 83% and 65% for 3- and 5-year periods, respectively.


CONCLUSIONS
Calcification of coronary arteries and the ascending aorta is a serious problem in long-term dialysis patients. However using arterial grafts, preferentially, in situ, seems to provide a practical alternative to minimize manipulating the ascending aorta during coronary artery bypass grafting, with acceptable perioperative morbidity and mortality rates and long-term survival.
Nakayama
Y
Y
Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamotoshi, Japan.
Sakata
R
R
Ura
M
M
Miyamoto
T A
TA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011183:Postoperative Complications / Q000401:mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate