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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2015 October;56(5):809-16
Long-term results of coronary artery bypass grafting in patients with dialysis-dependent renal failure
Hsu H. L. 1, Hsu H. P. 2, Yu B. F. 3, Lu T. M. 4, 5, Huang C. Y. 1, Shih C. C. 1, 5, Cheng B. C. 2, 6, Hsu C. P. 1, 5 ✉
1 Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;
2 Division of Cardiovascular Surgery and Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan;
3 Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan;
4 Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;
5 National Yang‑Ming University, School of Medicine, Taipei, Taiwan;
6 Department of Biotechnology, Southern Taiwan University, Tainan, Taiwan
AIM: Coronary artery disease is the main cause of mortality and morbidity in dialysis-dependent renal failure patients. Both the prevalence and incidence of renal failure are high in Taiwan. However, there were few reports exploring the outcome of coronary aortic bypass grafting (CABG) in these patients. The aim of this study was to determine the survival outcome and risk factors for mortality from CABG in this population.
METHODS: The operative, early postoperative and late results of 170 dialysis patients undergoing isolated coronary artery bypass grafting from January, 2000 to January, 2012 were retrospectively reviewed. Operative mortality, long-term survival, and risk factors were analyzed.
RESULTS: One hundred and seventeen patients (68.8%) were male, and the mean age was 61.5±10.3 years (range, 34-86 years). Follow-up was 40.3±32.1 months. Operative mortality was 8.2%. Actuarial survival, including operative mortality, was 81±3% at 1 year, 68±4% at 3 years, 58±5% at 5 years and 49±6% at 10 years, better than the natural course of dialysis-dependent renal failure patients. Age, emergent operation, postoperative ventricular tachycardia or fibrillation, postoperative intra-aortic balloon pump insertion, gastrointestinal bleeding, and left internal mammary artery graft were significant predictors of operative or long term mortality. Most causes of late death were due to infection or cardiac events.
CONCLUSION: CABG in dialysis patients is associated with a higher incidence of complications, but has acceptable mortality. CABG is beneficial in this population. Internal mammary artery grafting may provide more favorable long term outcomes.