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Outcome of coronary artery bypass operations in patients with renal insufficiency with and without renal transplantation

, : Outcome of coronary artery bypass operations in patients with renal insufficiency with and without renal transplantation. Chest 128(2): 855-862

Hypothesis: Renal insufficiency (RI) is associated with an increased risk of morbidity and mortality following coronary artery bypass graft (CABG) operations, particularly among patients who are dependent on dialysis.Design and setting: A retrospective analysis of data collected at a tertiary care center.Patients: One hundred eighty-four consecutive patients with RI who underwent CABG surgery between 1992 and 2004. This group consisted of 152 patients with serum creatinine levels of >= 1.7 mg/dL (group 1) and 32 kidney transplant recipients (group 11). Of the patients in group 1, 90 were dialysis-free (subgroup IA) and 62 were dialysis-dependent (subgroup 111). Main outcome measures: Demographics, perioperative data, and outcomes for each of the three groups were evaluated and compared. Results: Fifty-four percent of the patients were in New York Heart Association classes III and IV, 36% had unstable angina, and 21% had left main coronary disease. The mean ejection fraction was 38%. The median postoperative length of stay in the hospital was 10 days. Of the patients in group 113, 8% required reexploration for bleeding compared to 3% in groups IA and 11 (p < 0.05). Dialysis was needed postoperatively in five patients in group IA and two patients in group 11 (5.7%). The raw operative mortality rate was 7.6% and was higher in group 111 (9.7%) compared to groups IA and 11 (6.7% and 6.2%, respectively; p < 0.05). The actuarial 5-year survival rate was higher in group 11 compared to group 1 (79% vs 59%, respectively; p < 0.05). The difference in survival rates was more apparent between groups 11 and IB (79% vs 57%, respectively; p < 0.005).Conclusions: CABG is associated with an increased rate of perioperative complications and mortality in patients with RI. Dialysis dependence is a major risk factor for patients undergoing CABG surgery. However, with acceptable surgical results, dialysis patients should not be denied CABG surgery. A survival advantage is demonstrated among patients with previous kidney transplants compared to those patients who are dependent on dialysis.


PMID: 16100178

DOI: 10.1378/chest.128.2.855

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