Coronary artery bypass grafting in 105 patients with hemodialysis-dependent renal failure

This study was proposed to define early and long-term results of coronary a rtery bypass grafting (CABG) in dialysis-dependent renal failure (RF) patie nts, and preoperative patient characteristics. This study included 105 pati ents (87 males and 18 females; mean age 60.0 +/- 9.0 years, range 39-79) wi th RF on maintenance dialysis (hemodialysis 100, peritoneal dialysis 5) who underwent isolated CABG between August 1985 and April 2000. Postoperative follow-up was completed in 100% and averaged 3.1 years. There were 22 emerg ency and 2 re-CABG cases. Previous myocardial infarction (MI) was found in 55 patients (52%), and unstable angina was noted in 53 patients (50%). Diab etes mellitus was the cause of RF in 50 patients (48%; 24 patients required insulin). There was 1 case of single vessel disease, 31 cases of double ve ssel disease, 54 cases of triple vessel disease, and 19 cases of left main disease. Preoperative left ventriculography was performed in 92 patients (8 8%). Left ventricular ejection fraction (LVEF) was 48.3 +/- 15.8% (range 11 -74%) and was 40% or less in 25 patients (27%). The mean number of distal a nastomoses was 2.5 (range 1-5). Three patients received only vein grafts, b ut all were cases of emergency CABG. The remaining 102 patients (97%) recei ved at least 1 arterial conduit. Among them, 64 patients received only arte rial conduits, and 72 patients received 2 or more distal anastomoses with a rterial conduits. Five patients (4.8%) died within 30 days after CABG (2 ca rdiac deaths and 3 noncardiac deaths), and 8 patients (7.6%) died beyond 30 days after CABG before discharge (all noncardiac deaths). The cause of 2 c ardiac deaths was abrupt circulatory collapse during or after hemodialysis in patients with severe left ventricular dysfunction (LVEF; 11% and 28%) in the early postoperative period. The causes of 8 noncardiac deaths included infection in 4 and rupture of aortic aneurysm, stroke, sleep apnea syndrom e, and mesenteric infarction. During the follow-up period, there were 29 la te deaths (8 cardiac, 13 noncardiac, and 8 sudden death), 6 MIs, 13 percuta neous transluminal coronary angioplasty, and 1 re-CABG. The 5-year actuaria l survival rate was 59.8%, the cardiac death-free rate was 83.0%, and the c ardiac event-free rate was 62.4%. Although CABG in patients on hemodialysis is associated with high early and long-term mortality in terms of both car diac and noncardiac deaths in proportion to the severity of the preoperativ e condition, long-term survival was still better than that of general dialy sis patients. Meticulous perioperative management may be the key factor in the improvement of early results.