Coronary artery bypass grafting in dialysis patients

Background. To analyze the characteristic problems of coronary artery bypas s grafting in patients with chronic renal failure. Methods. Fifty-one consecutive dialysis patients who required isolated coro nary bypass grafting over a 9-year period were studied retrospectively. Results. Nine patients (18%) had emergent operation, 4 of whom had intraaor tic 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 g astroepiploic artery and one of which used bilateral internal mammary arter y grafts. A mean of 4.2 +/- 2.6 coronary artery segments were calcific acco rding to American Heart Association classification. Eight patients (16%) re quired operative modifications to avoid manipulating calcific plaques on th e ascending aorta. Four patients (7.8%) died, and 15 had nonlethal complica tions. The actuarial survival rates in 47 hospital survivors at 1, 3, and 5 years were overall 89%, 84%, and 71%, respectively, and estimates for card iac 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 gr afts, preferentially, in situ, seems to provide a practical alternative to minimize manipulating the ascending aorta during coronary artery bypass gra fting, with acceptable perioperative morbidity and mortality rates and long -term survival. (C) 1999 by The Society of Thoracic Surgeons.