Document Detail


Outcome of coronary artery bypass operations in patients with renal insufficiency with and without renal transplantation.
MedLine Citation:
PMID:  16100178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 > or = 1.7 mg/dL (group I) and 32 kidney transplant recipients (group II). Of the patients in group I, 90 were dialysis-free (subgroup IA) and 62 were dialysis-dependent (subgroup IB). 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 IB, 8% required reexploration for bleeding compared to 3% in groups IA and II (p < 0.05). Dialysis was needed postoperatively in five patients in group IA and two patients in group II (5.7%). The raw operative mortality rate was 7.6% and was higher in group IB (9.7%) compared to groups IA and II (6.7% and 6.2%, respectively; p < 0.05). The actuarial 5-year survival rate was higher in group II compared to group I (79% vs 59%, respectively; p < 0.05). The difference in survival rates was more apparent between groups II 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.
Authors:
Malek G Massad; Jacques Kpodonu; John Lee; Joseph Espat; Sanjay Gandhi; Amul Tevar; Alexander S Geha
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Chest     Volume:  128     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-15     Completed Date:  2005-09-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  855-62     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, 840 S Wood St, CSB Suite 417 (MC 958), Chicago, IL 60612, USA. mmassad@uic.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass / adverse effects*
Female
Follow-Up Studies
Humans
Kidney Failure / epidemiology,  etiology*
Kidney Transplantation*
Male
Middle Aged
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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