Outcome of Coronary Artery Bypass Grafting in End StageRenal Disease Patients

ABSTRACT

Introduction: End stage renal disease (ESRD) patients have a much higher rate of cardiac disease and cardiac mortality as compared with the general population. Revascularisation such as coronary artery bypass grafting (CABG) may also carry a higher rate of complications and morbidity. We compared our ESRD patients who underwent CABG with the general population and ESRD population. Methods: This is an observational study of ESRD patients who underwent CABG in our centre from 2003-2009 with case-control matching comparison with non-ESRD patients for ICU and hospital stay; and ESRD patients without CABG for survival. Patients with concomitant valvular operation were excluded. The primary outcomes were peri-operative complications and survival. Results: Eleven patients with mean age of 57.5±8.5 were included. All except 1 were diabetics. One patient had excessive haemorrhage requiring immediate re-thoracotomy, and t hi s was complicate d with thro mbosed AVF. Four patients e x perienced intr adialytic hyp otension postoperatively but all resolved within 1 week. Both ESRD and non-ESRD patients had equal number of ICU stay (3.1 versus 3.2 days, p=0.906) and hospital stay (7.6 versus 6.9 days, p=0.538). With average of 3.3 years follow-up (range from 1 to 7 years), 4 deaths were observed but only one from cardiac cause. Both ESRD cohorts with or without CABG have compatible left ventricular mass 295 ± 86 vs 343 ± 113 g (p=0.226) and left ventricular mass 174 ± 54 vs 206 ± 63 g/m2( p=0.157). The ou tco me of CAB G ESRD patien ts was comparable to matched ESRD patients without CABG with 90.9 % versus 91.9% 1 year survival, 95.5% versus 77.7% 2 year survival, 71.4% versus 70.3% 3 year and 40.0% versus 40.3% at 5 year survival (p=0.627, 0.386, 0.659 and 0.683 respectively). Conclusion: CABG in ESRD patients carries an acceptable perioperative complication rate. They have acceptable ICU and hospitalization duration in comparison to non-ESRD patients.Their long term survival was at least as good as matched ESRD patients without CABG.