Outcome of coronary artery bypass grafting in end stage renal disease patients.

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 this was complicated with thrombosed AVF. Four patients experienced intradialytic hypotension 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 outcome of CABG ESRD patients 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.