Short-term outcome of coronary artery bypass graft surgery in end stage renal failure dialysis-dependent patients

Abstract

Background Patients with end-stage renal disease (ESRD) requiring dialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative morbidity and mortality. We describe our own experience in such high risk subgroup of patients. Methods Over four years period, a retrospective analysis of fifteen patients with dialysis-dependent renal failure who underwent coronary artery bypass grafting. Mean age was 55 ± 12 years. Except from one patient who was on peritoneal dialysis, all other patients were on regular hemodialysis. five patients were referred to cardiac surgery as their coronary artery disease was detected during routine coronary angiography before renal transplant. Results There was one postoperative death (in-hospital mortality, 6.6%). The patient who died was suffering from morbid obesity with severe LV dysfunction and poor target coronary artery vessels. Three patients underwent renal transplantation after CABG operation and another one patient was recently operated and is waiting for transplant. One patient was complicated with significant perioperative MI after having LAD endartrectomy and surgical reconstruction with LIMA; this was complicated with heart failure and moderate to severe MR. This patient had lost his chance for future renal transplant. One patient had cerebral hemorrhage 2 months after surgery and he recovered. Conclusions Cardiac operations in patients with end-stage renal disease may be performed with a fairly low perioperative risk and the perspective of short-term functional improvement and acceptable survival. However, careful selection is mandatory for better outcome.