Coronary Artery Bypass Surgery in Patients on Maintenance Dialysis: Long-Term Survival

Coronary artery bypass grafting (CABG) can be performed with acceptable risk and results in symptomatic improvement in patients with end-stage renal disease (ESRD). However, the effect of CABG on long-term survival in these patients is unknown. We retrospectively identified 39 patients (group 1) with ESRD who underwent CABG for intractable angina between January 1975 and February 1987 while on maintenance dialysis. Thirty-nine dialysis patients (group 2) were also retrospectively selected for comparison and matched for age, sex, year of initiation, length of time on dialysis, and presence of diabetes mellitus and atherosclerotic heart disease at initiation of dialysis. Using life-table analysis, survival probability (with 95% confidence limits) was determined from the time of CABG for group 1 or after an equivalent period of time on dialysis for group 2. Two life-table analyses were performed; one with study end-points of death, withdrawal (renal transplantation, transfer to other dialysis facilities, and reoperation), and alive on dialysis; and a second with identical end points except that noncardiac deaths were treated as withdrawals. Coronary arteriography revealed severe three vessel disease, left ventricular dysfunction, and segmental wall motion abnormalities in most patients. A mean (± SD) of 2.56 ± 0.75 vessels were bypassed with an operative mortality (30 days) of 2.6%. Mean follow-up after CABG in group 1 was 34.9 ± 30.1 months, and in most patients functional classification improved. Mean follow-up for group 2 was 17.2 ± 15.2 months. Two-year survival was 91.7% in group 1 and 51.4% in group 2 (P ± 0.05). However, there was no significant difference betwen survival probabilities when the risk of cardiac death was assessed. These data suggest that the risk of cardiac death after CABG in ESRD patients with symptomatic severe coronary artery disease is comparable to that of ESRD patients with much less severe disease. Additionally, they demonstrate a low operative mortality, improved functional status, and remarkably good long-term survival after CABG in patients on maintenance dialysis.