Coronary artery bypass surgery in patients with end stage renal disease: overall outcome in single centre experience

Coronary artery bypass surgery and its entire perioperative management is demanding in patients with end stage renal disease [ESRD]. We included data from all patients on hemodialysis who underwent coronary artery bypass grafting [CABG] between November 1st, 2003 and November 1st, 2006 at Sheikh Zayed hospital and Federal postgraduate medical institute, Lahore, Pakistan. During the study period 41 patients with end stage renal disease underwent coronary artery bypass grafting at the Sheikh Zayed hospital and Federal postgraduate medical institute, Lahore. Among these patients, we recorded a perioperative mortality of 19.51%. Six months survival rate was 75.60% among study group patients. The incidence of peripheral artery disease is reported significantly higher in the dialysis dependent patients. Uremic patients showed significantly lower hemoglobin serum levels [4], fresh frozen plasmas [FFP's] when needed. Our preliminary study indicates that coronary artery bypass surgery can be performed with acceptable midterm results when the specific requirements of this patient group are taken into account

Peculiarity of surgical tactics for management of ischemic heart disease in patients with left main coronary artery stenosis

The left main coronary artery disease has poor natural history. Sudden death, massive myocardial infarction, angina and poor quality of life indicate the ominous nature of the disease. Coronary artery bypass grafting remains the ultimate choice of its management. A relatively high mortality and morbidity of its surgical treatment described in literature leads to the actuality of this disease. This work is a part of our continuous effort for refinements in anesthetic and surgical techniques to reduce mortality and morbidity in such patients and is in the clinical practice at our institute for the last few years. During the period from February 1998 to October 2005, 74 patients underwent coronary artery bypass surgery for left main coronary artery stenoses, at Federal Postgraduate Medical Institute, Shaikh Zayed Hospital, Lahore. All patients presented with angina, unstable in 62.2%. An old myocardial Infarction was present in 52 [70.3%] patients. An emergent surgery was needed in 5[6.8%], urgent operation was performed in 45[60.8%] patients and elective procedure was done in 24[32.4%]. Average stay in the hospital was 9.0+2.7 days. There were 2 hospital deaths and one late non cardiac death. The post operative recovery was eventless in majority of the patients. The return of patients to their jobs improved significantly [P < 0.005] three months after operation. Our current surgical results are certainly improved than many previous studies on coronary artery bypass grafting for left main stem stenoses