Early and long term results of coronary artery bypass grafts in patients with dialysis dependant renal failure

Objective: Coronary artery disease is the main cause of mortality and morbi dity in patients on renal therapy replacement. The aim of this study was to define peri-operative risk and long term results of coronary artery bypass grafts (CABG) in dialysis patients. Methods: this retrospective study incl uded 82 patients in chronic dialysis who underwent CABG between 1978 and 19 97. The mean age was 61 +/- 10 years (range 28-81 years), 84% of the patien ts were male and the average duration of dialysis was 57 months (range 1-14 8 months). Combined procedures were carotid endarterectomy in one case, lef t ventricular aneurysm resection in one and valvular replacement in 10 (nin e aortic and one mitral replacements). The operation was elective in 42 pat ients (51%) and urgent in the others. Previous myocardial infarction was fo und in 37 patients (45%) and left ventricular ejection fraction (LVEF) at l ess than 45% in 15 patients (18%); 23 patients (28%) were in NYHA class III or IV and regarding angina functional status, 77% in CCS class 3 or 4. Fol low-up was complete. Statistical analysis included 30 and pre and peri-oper ative data. Statistical analysis used Chi-square analysis or Fisher's exact test, and the Mann-Whitney test when appropriate, The estimated probabilit y of survival, including postoperative mortality, was calculated by the met hod of Kaplan-Meyer, and the Log-Rank test used to compare the results. Res ults: the hospital mortality was 14.6% (n = 12). Ischemic time and ECC time were significantly lengthened in dead patients (P = 0.01). Moreover, use o f internal mammary artery was directly related to lower hospital mortality (P = 0.02). For previous myocardial infarction, LVEF at less than 45%, diab etes and combined procedure, a P-value of less than or equal to 0.1 was cal culated. The follow-up ranged from 1 to 140 months (mean 36 months). There were 39 late deaths. The survival rates (included hospital mortality) were 71 +/- 5%, 56 +/- 6% and 39 +/- 6% at 1, 3 and 5 years, respectively. All s urviving patients improved their functional status and had symptomatic reli ef. Statistical analysis showed significant difference in favor of long ter m survival for patients younger than 60 years, LVEF > 45% and NYHA class I or II. Conclusion: these data confirm that CABG in patients with renal repl acement therapy is associated with an high operative and long term mortalit y. However it allows an improvement of functional status, and so, let possi ble duration of dialysis. It may be expected that more active prevention an d detection of coronary disease might improve these results. (C) 1999 Elsev ier Science B.V. All rights reserved.