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.