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Ann Thorac Surg. 2010 Sep;90(3):738-43. doi: 10.1016/j.athoracsur.2010.04.069.

Long-term survival after coronary arterial grafts in patients with end-stage renal disease.

Author information

1
Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto City, Japan. nakatsu-taro@hotmail.co.jp

Abstract

BACKGROUND:

Bilateral internal thoracic artery (BITA) grafting is known to improve the long-term survival after coronary artery bypass grafting (CABG). However, there are few reports regarding the efficacy of BITA grafting in end-stage renal disease (ESRD) patients. This study investigates the potential benefits of BITA grafting in ESRD patients.

METHODS:

One hundred thirty ESRD patients dependent on chronic hemodialysis underwent isolated CABG in the Kumamoto Central Hospital from 1988 to 2009. The early results and long-term outcomes in 49 patients using BITA (BITA group) were compared with 81 patients using a single ITA (SITA group). The mean follow-up time was 5.2 +/- 3.8 years.

RESULTS:

The mortality rate was 4.9% for the SITA group and 4.1% for the BITA group (p = 0.8215). No differences were seen for the incidence of mediastinitis or a rethoracotomy for bleeding. The 3-year, 5-year, 7-year, and 10-year survival rates in the SITA group were 79.6%, 62.5%, 43.6%, and 22.6%, respectively. The corresponding survival rates in the BITA group were 76.0%, 61.9%, 58.8%, and 33.2%, respectively. There were no statistical differences in survival (p = 0.1636), freedom from cardiac death (p = 0.3205), or freedom from cardiac events (p = 0.4071). In ESRD patients without diabetes mellitus, BITA grafting improves the outcomes concerning cardiac events (p = 0.0143).

CONCLUSIONS:

After a long-term follow-up, CABG with BITA grafts showed no advantages in the long-term outcomes among ESRD patients. However, for ESRD patients without diabetes mellitus, BITA grafting may provide more promising long-term outcomes.

[Indexed for MEDLINE]

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