Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine >= 2.0 mg/dl)

Introduction: Patients with renal dysfunction carry a risk of coronary athe rosclerosis. The purpose of this study was to evaluate the outcome after co ronary artery bypass grafting (CABG) in patients with decreased renal funct ion (serum creatinine greater than or equal to2.0 mg/dl). Methods: We retro spectively analyzed consecutive patients who had undergone isolated CABG at Shin-Tokyo Hospital between May 1, 1991 and April 31, 2000. Preoperative, perioperative, and follow-up data of the non-dialysis-dependent patients wi th preoperative serum creatinine equal to or more than 2.0 mg/dl (group R, n = 59) were collected, and compared with those of the control patients (se rum creatinine <2.0, group C, n = 1666). Group R was further divided into t he off-pump and on-pump CABG group and their perioperative results were com pared. Results: Group R included 51 males and eight females with a mean age of 66.4. The mean number of anastomoses was not significantly different be tween groups; however, clump time and pump time were longer in group R. Pos toperative recovery was longer in group R than in group C, which is associa ted with a more frequent occurrence of major complications (28.8% in group R and 10.7% in group C, P < 0.0001) and mortalities (6.8% in group R and 0. 5% in group C, P < 0.0005). The patients who underwent off-pump CABG experi enced relatively faster recovery than those who underwent on-pump CABG, des pite decreased renal function. At the mean followup of 2.4 years, the actua rial 3-year survival rate of groups R and C were 75.3 and 96.9%, respective ly (P < 0.0001), excluding hospital mortality. The actuarial 3-year cardiac event-free rate was 76.7% in group R and 87.3% in group C (P < 0.05). Conc lusions: Patients with decreased renal function carry significant operative risks and require prolonged hospital care. Even after adequate surgical re vascularization was completed, the long-term cardiac event-free and surviva l rates in the patients with renal dysfunction were inferior to the patient s with normal renal function. (C) 2001 Elsevier Science B.V. All rights res erved.