Abstract
Background: Renal dialysis patients are a subgroup at major operative risk when undergoing coronary
artery bypass grafting (CABG). Even though CABG without cardiopulmonary bypass (CPB)
has decreased the surgical risk and provided good short-term results, the long-term
survival seems uncertain. We report here on the long-term outcome of CABG without
CPB in renal dialysis patients. Methods: From 1998 to 2002, 44 renal dialysis patients underwent elective CABG without CPB,
including 17 minimally invasive direct coronary artery bypass (MIDCAB) and 27 off-pump
CABG (OPCAB) procedures. There were 5 one-vessel, 12 two-vessel and 27 multi-vessel
coronary artery disease patients, who mainly had left internal thoracic artery (LITA)
to left anterior descending coronary artery (LAD) grafting with an additional saphenous
vein graft to non-LAD coronaries. Results: All 44 patients were followed up for 44.4 ± 31.2 months. Three (6.8 %) surgical deaths
within 30 days occurred and 25 late mortalities happened over a period of 2 – 79 months.
The 5-year cumulative rate of total survival is 38.2 % and the freedom from cardiac
death is 70.9 %. Using hazard analysis, old age (> 60 years) and incomplete coronary
revascularization was found to significantly affect the total survival. Conclusions: CABG without CPB provided an acceptable surgical mortality and morbidity. The high
incidence of non-cardiac death associated with dialysis complications had an adverse
impact on the overall outcome. The LITA bypass operation method combined with intensive
care for dialysis complications would hopefully fulfill the goal to improve the short-
and long-term results in this subgroup.
Key words
CABG without CPB - MIDCAB - OPCAB - renal dialysis - uremic - coronary bypass surgery
References
- 1
Franga D L, Kratz J M, Crumbley A J, Zellner J L, Stroud M R, Crawford F A.
Early and long-term results of coronary artery bypass grafting in dialysis patients.
Ann Thorac Surg.
2000;
70
813-818
- 2
Blakeman B P, Sullivan H J, Foy B K, Sobotka P A, Pifarre R.
Internal mammary artery revascularization in the patient on long-term renal dialysis.
Ann Thorac Surg.
1990;
50
776-778
- 3
Hannan E L, Racz M J, Walford G, Jones R H, Ryan T J, Bennett E. et al .
Long-term outcomes of coronary-artery bypass grafting versus stent implantation.
N Engl J Med.
2005;
352
2174-2183
- 4
Ahmed W H, Shubrooks S J, Gibson C M, Baim D S, Bittl J A.
Complications and long-term outcome after percutaneous coronary angioplasty in chronic
hemodialysis patients.
Am Heart J.
1994;
128
252-255
- 5
Kahn J K, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Hartzler G O.
Short- and long-term outcome of percutaneous transluminal coronary angioplasty in
chronic dialysis patients.
Am Heart J.
1990;
119
484-489
- 6
Opsahl J A, Husebye D G, Helseth H K, Collins A J.
Coronary artery bypass surgery in patients on maintenance dialysis: long-term survival.
Am J Kidney Dis.
1988;
12
271-274
- 7
Batiuk T D, Kurtz S B, Oh J K, Orszulak T A.
Coronary artery bypass operation in dialysis patients.
Mayo Clin Proc.
1991;
66
45-53
- 8
Jahangiri M, Wright J, Edmondson S, Magee P.
Coronary artery bypass graft surgery in dialysis patients.
Heart.
1997;
78
343-345
- 9
Owen C H, Cummings R G, Sell T L, Schwab S J, Jones R H, Glower D D.
Coronary artery bypass grafting in patients with dialysis-dependent renal failure.
Ann Thorac Surg.
1994;
58
1729-1733
- 10
Lichtenberg A, Klima U, Paeschke H, Pichlmaier M, Ringes-Lichtenberg S, Walles T.
et al .
Impact of multivessel coronary artery disease on outcome after isolated minimally
invasive bypass grafting of the left anterior descending artery.
Ann Thorac Surg.
2004;
78
487-491
- 11
Lattouf O M, Puskas J D, Thourani V H, Noora J, Kilgo P D, Guyton R A.
Does the number of grafts influence surgeon choice and patient benefit of off-pump
over conventional on-pump coronary artery revascularization in multivessel coronary
artery disease?.
Ann Thorac Surg.
2007;
84
1485-1494
- 12
Ariyoshi T, Eishi K, Yamachika S, Hazama S, Takai H, Odate T. et al .
Perioperative and mid-term results of coronary bypass surgery in patients undergoing
chronic dialysis.
Ann Thorac Cardiovasc Surg.
2006;
12
257-264
- 13
Cohen H A, Zenati M, Smith A J, Lee J S, Chough S, Jafar Z. et al .
Feasibility of combined percutaneous transluminal angioplasty and minimally invasive
direct coronary artery bypass in patients with multivessel coronary artery disease.
Circulation.
1998;
98
1048-1050
- 14
Leimgruber P P, Roubin G S, Hollman J, Cotsonis G A, Meier B, Douglas J S. et al .
Restenosis after successful coronary angioplasty in patients with single-vessel disease.
Circulation.
1986;
73
710-717
- 15
Rinehart A L, Herzog C A, Collins A J, Flack J M, Ma J Z, Opsahl J A.
A comparison of coronary angioplasty and coronary artery bypass grafting outcomes
in chronic dialysis patients.
Am J Kidney Dis.
1995;
25
281-290
- 16
Koyanagi T, Nishida H, Endo M, Koyanagi H.
Coronary artery bypass grafting in chronic renal dialysis patients: intensive perioperative
dialysis and extensive usage of arterial grafts.
Eur J Cardiothorac Surg.
1994;
8
505-507
- 17
Nakayama Y, Sakata R, Ura M, Miyamoto T A.
Coronary artery bypass grafting in dialysis patients.
Ann Thorac Surg.
1999;
68
1257-1261
- 18
Mack M J, Pfister A, Bachand D, Emery R, Magee M J, Connolly M. et al .
Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients
with multivessel disease.
J Thorac Cardiovasc Surg.
2004;
127
167-173
- 19
Garrido P, Bobadilla J F, Albertos J, Gonzalez S J, Bastida E, Vallejo J L. et al
.
Cardiac surgery in patients under chronic hemodialysis.
Eur J Cardiothorac Surg.
1995;
9
36-39
- 20
Koyanagi T, Nishida H, Kitamura M, Endo M, Koyanagi H, Kawaguchi M. et al .
Comparison of clinical outcomes of coronary artery bypass grafting and percutaneous
transluminal coronary angioplasty in renal dialysis patients.
Ann Thorac Surg.
1996;
61
1793-1796
- 21
Tugtekin S, Kappert U, Jarny K, Knaut M, Cichon R, Alexiou K. et al .
Coronary surgery in dialysis-dependent patients with end-stage renal failure with
and without extracorporeal circulation.
Thorac Cardiovasc Surg.
2007;
55
84-88
- 22
Brown J M, Poston R S, Gammie J S, Cardarelli M G, Schwartz K, Sikora J A. et al .
Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making
algorithm and outcomes.
Ann Thorac Surg.
2006;
81
555-561
- 23
Dewey T M, Herbert M A, Prince S L, Robbins C L, Worley C M, Magee M J. et al .
Does coronary artery bypass graft surgery improve survival among patients with end-stage
renal disease?.
Ann Thorac Surg.
2006;
81
591-598
- 24
Nakayama Y, Sakata R, Ura M, Itoh T.
Long-term results of coronary artery bypass grafting in patients with renal insuficiency.
Ann Thorac Surg.
2003;
75
500
- 25
Jones E L, Weintraub W S.
The importance of completeness of revascularization during long-term follow-up after
coronary artery operations.
J Thorac Cardiovasc Surg.
1996;
112
227-237
- 26
Faxon D P, Ghalilli K, Jacobs A K, Ruocco N A, Christellis E M, Kellett Jr M A. et
al .
The degree of revascularization and outcome after multivessel coronary angioplasty.
Am Heart J.
1992;
123
854-859
- 27
Sergeant P, Blackstone E, Meyns B.
Is return of angina after coronary artery bypass grafting immutable, can it be delayed,
and is it important?.
J Thorac Cardiovasc Surg.
1998;
116
440-453
Dr. Chia-Hsun Lin
Cardiovascular Surgery
Shin Kong Wu Ho-Su Memorial Hospital
No 95, Wen-Chang Road, Shih-lin 111, Taipei
Taiwan Republic of China
Email: m000678@ms.skh.org.tw
