Coronary artery bypass grafting in chronic renal dialysis patients: intensive perioperative dialysis and extensive usage of arterial grafts.

Twenty-three chronic renal dialysis patients underwent coronary artery bypass grafting (CABG). Eighteen patients were maintained on hemodialysis and 5 patients received continuous ambulatory peritoneal dialysis. Eighteen patients (78%) had triple vessel disease or left main disease. The mean number of revascularized vessels was 2.2 +/- 0.8, and the graft materials used were left internal thoracic artery (21), right internal thoracic artery (7), right gastroepiploic artery (7), and saphenous vein (15). The utilization index of arterial grafts (percentage of patients with at least one arterial graft) was 95.7%. Intraoperative hemodialysis (HD) was performed during cardiopulmonary bypass in all patients. In 17 patients on HD preoperatively, peritoneal dialysis (PD) was initiated immediately after the operation, and maintained until the hemodynamics stabilized sufficiently to resume HD (mean: 5.7 +/- 3.4 days after operation). In the patients with a gastroepiploic artery pedicle, PD could be established without leakage of dialysis fluid into the pericardial cavity by means of making a smaller hole in the diaphragm, passing the skeletonized portion of the graft through the hole and sealing the hole using fibrin glue. There were no hospital deaths. Angiography revealed an overall graft patency rate of 95.8% (46/48), and all arterial grafts were patent. There were 4 late deaths (1 cardiac, 3 cerebral hemorrhage). In conclusion, CABG can be accomplished in chronic renal dialysis patients with excellent early and long-term results through an intensive perioperative dialysis program and extensive usage of arterial grafts.