Long-term results of dialysis patients with chronic kidney disease undergoing coronary artery bypass grafting.

PURPOSE: Recently, coronary atrial bypass grafting (CABG) for dialysis patients increase, but the mortality is still high. Additionally, many patients show major adverse cardiovascular and cerebrovascular event (MACCE) after discharge and long-term results are not satisfactory.

METHODS: Ninety patients underwent CABG for dialysis patients. Logistic regression analysis was conducted using preoperative and intraoperative factors in relation to the early death and MACCE.

RESULTS: The operative mortality rate was 8.9% (isolated CABG: 6.9%, concomitant surgery: 16.7%). All death patients having isolated CABG were emergent cases. The postoperative survival rate was 81.5 ± 18.5% at 1 year, 72.0 ± 28.0% at 5 years and 68.4 ± 31.6% at 8 years. The postoperative MACCE-free rate was 70.3 ± 29.7% at 1 year, 61.8 ± 38.2% at 5 years, and 58.6 ± 41.4% at 8 years. We identified acute myocardial infarction, age ≥75 years, preoperative intra aortic balloon pumping assist (IABP), concomitant surgery, and non-use carperitide as risk factors for early death and ejection fraction <40%, preoperative IABP assist, and non-use of carperitide as risk factors for postoperative MACCE.

CONCLUSIONS: The present study suggested that surgical outcome of CABG in dialysis patients was not satisfactory. Especially, patients with preoperative left ventricular dysfunction, IABP assist, and concomitant surgery were resulted in poor outcome. It is suggested that dialysis patients need not only surgery but also multidisciplinary therapy.