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Early and mid-term results of off-pump coronary artery bypass grafting in patients with end stage renal disease: surgical outcomes after achievement of complete revascularization

^a Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA
^b Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
^c Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA

*Corresponding author. Tel.: +1-216-445-9333; fax: +1-216-444-9198.

E-mail address: thourai-tky{at}umin.ac.jp (T. Horai).

End stage renal disease is a risk factor for mortality after coronary artery bypass grafting. We conducted a retrospective review of 37 consecutive dialysis-dependent patients who underwent off-pump coronary artery bypass grafting between April 2001 and July 2004. Complete revascularization was successfully performed in all patients. The mean number of anastomoses was 3.7, and early graft patency was 98.8%. Thirty-day mortality was 2.7%. In-hospital mortality was 8.1%. At a mean follow-up of 26 months, there were six late deaths including one cardiac death, and five cardiac events. Actuarial survival rate at one and three years was 88.8% and 77.0%, respectively. Cardiac event free rate at one and three years was 85.9% and 72.6%, respectively. Multivariate analysis revealed that preoperative left ventricular ejection fraction (P=0.003) and smoking history (P=0.026) were significant predictors for mid-term mortality, and co-existing peripheral vascular disease was a significant predictor for cardiac events (P=0.033). Early and mid-term outcomes after off-pump coronary artery bypass grafting in patients with end stage renal disease have acceptable mortality rate with excellent early graft patency, while low ejection fraction and smoking history were significant risk factors for mid-term survival, and co-existing peripheral vascular disease was a significant predictor for cardiac events.

Key Words: Off-pump coronary artery bypass; Dialysis; Chronic renal insufficiency