Coronary artery bypass grafting in chronic renal dialysis patients:intensive perioperative dialysis and extensive usage of arterial grafts

Abstract

Twenty-three chronic renal dialysis patients underwent coronary arterybypass grafting (CABG). Eighteen patients were maintained on hemodialysisand 5 patients received continuous ambulatory peritoneal dialysis. Eighteenpatients (78%) had triple vessel disease or left main disease. The meannumber of revascularized vessels was 2.2 +/- 0.8, and the graft materialsused were left internal thoracic artery (21), right internal thoracicartery (7), right gastroepiploic artery (7), and saphenous vein (15). Theutilization index of arterial grafts (percentage of patients with at leastone arterial graft) was 95.7%. Intraoperative hemodialysis (HD) wasperformed during cardiopulmonary bypass in all patients. In 17 patients onHD preoperatively, peritoneal dialysis (PD) was initiated immediately afterthe operation, and maintained until the hemodynamics stabilizedsufficiently to resume HD (mean: 5.7 +/- 3.4 days after operation). In thepatients with a gastroepiploic artery pedicle, PD could be establishedwithout leakage of dialysis fluid into the pericardial cavity by means ofmaking a smaller hole in the diaphragm, passing the skeletonized portion ofthe graft through the hole and sealing the hole using fibrin glue. Therewere no hospital deaths. Angiography revealed an overall graft patency rateof 95.8% (46/48), and all arterial grafts were patent. There were 4 latedeaths (1 cardiac, 3 cerebral hemorrhage). In conclusion, CABG can beaccomplished in chronic renal dialysis patients with excellent early andlong-term results through an intensive perioperative dialysis program andextensive usage of arterial grafts.