Coronary surgery in dialysis-dependent patients with end-stage renal failure with and without extracorporeal circulation.
Coronary artery bypass grafting (CABG) in dialysis-dependent patients with end-stage renal failure (ESRF) has become the standard treatment for CAD in this patient group, but is still considered as a risk procedure due to the increased mortality and morbidity. The avoidance of extracorporeal circulation in dialysis-dependent patients seems to be an attractive alternative. This retrospective study analyzed and compared our experience with CABG surgery with and without extracorporeal circulation in dialysis-dependent patients with ESRF. We analyzed the clinical results of isolated CABG in 73 dialysis-dependent patients with ESRF with and without the use of extracorporeal circulation. The on-pump group consisted of 43 patients (7 female and 36 male, 65 +/- 7.3 years) and the off-pump group included 30 patients (4 female and 26 male, 67 +/- 7.2 years). Demographic and preoperative data were comparable in both groups. Overall hospital mortality rate was 4.2 % (n = 3), two patients (4.6 %) in the on-pump group and one patient (3.3 %) in the off-pump group died due to noncardiac reasons. Morbidity was comparable in both groups. The mean number of grafts was 3.1 +/- 0.9 in the on-pump group and 2.9 +/- 0.8 in the off-pump group. During follow-up, 13 patients (30.2 %) in the on-pump group died, nine of these patients (69.2 %) due to cardiac reasons; eight patients (26.7 %) in the off-pump group died, mostly due to cardiac reasons (n = 5, 62.5 %). CABG can be performed in patients with dialysis-dependent ESRF with good clinical results and low morbidity with two different surgical approaches. Midterm results are still affected by cardiac events.
Tugtekin
S
S
Cardiac Surgery, Heart Center Dresden, Dresden, Germany. malte8554@yahoo.de
Kappert
U
U
Jarny
K
K
Knaut
M
M
Cichon
R
R
Alexiou
K
K
Matschke
K
K
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012107:Research Design; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome