Dion L. Frangas, John M. Kratz*, Arthur J. Crumbley*, James L. Zellner, Martha R. Stroud, Fred A. Crawford*

Medical University of South Carolina

Charleston, South Carolina, USA

Objective: Dialysis patients frequently present with debilitating coronary artery disease but are regarded as challenging patients for coronary artery bypass surgery (CABG). We reviewed our short and long term results with this procedure attempting to identify factors predicting success in improving the patient’s status.

The operative, early postoperative, and late results of 44 dialysis patients undergoing CABG from 1984 to 1997 were retrospectively reviewed. Follow-up was 100% complete.

Early results: Compared to CABG patients in the Society for Thoracic Surgery database only cerebrovascular accident 3(7%)(P=0.0355) and postoperative cardiac arrest 3(7%)(P=0.0195) occurred more frequently. However, 32(73%)(P<0.0001) had some type of complication. Operative mortality was 11.4%. Lower left ventricular ejection fraction (P=0.0280) and severe distal disease (P=0.0475) were predictive of increased operative mortality.

Late results: NYHA angina class fell from 2.8 to 1.5 and NYHA congestive class fell from 2.6 to 1.8. Overall quality of life scores did not improve; however walking distances remained consistently improved. Survival at five years was 32%. The only predictor of late mortality was a history of smoking. Six-year survival was 0% for smokers and 84% for nonsmokers (P=0.012). Causes of late death were myocardial infarction 4, sepsis 1, subdural hematoma 1, and unknown 6.

CABG should be avoided in dialysis patients with severe diffuse disease. Continued smoking is associated with poor outcome and every effort should be made to stop this destructive habit. CABG in dialysis patients is associated with a higher incidence of complications but can be performed with an acceptable operative mortality and is associated with good symptomatic relief of angina and heart failure.