Factors associated with early mortality in haemodialysis patients undergoing coronary artery bypass surgery

Abstract

SummaryIntroduction:Coronary artery bypass grafting (CABG) results in higher morbidity and mortality rates in end-stage renal disease (ESRD) patient populations than in patients with normal renal function. This study aimed to identify the early results of CABG performed on ESRD patients, and the factors that affected the mortality rates of those patients.Methods:A retrospective evaluation of our hospital database revealed 84 haemodialysis-receiving patients who underwent CABG during the years 2006 to 2012. Mortality was observed in 21 patients (group 1), and this group was compared with the remaining patients (group 2) for peri-operative parameters such as age, EuroSCORE, functional capacity, myocardial infarction, use of inotropes and completeness of revascularisation.Results:The study included 60 male (71.4%) and 24 female patients (28.6%); the participants’ mean age was 59.50 ± 9.93 years. The pre-operative additive EuroSCORE was 7.96 ± 2.88 (range: 2–18). Pre-operative functional capacity was impaired in 35.7% of the patients [New York Heart Association (NYHA) classes III–IV]. Mean age and preoperative EuroSCORE values of group 1 were significantly higher than those of group 2. Impaired functional capacity (NHYA classes III–IV) was also associated with mortality (OR: 3.333; 95% CI: 1.199–9.268).Fifty-four patients (64.3%) underwent on-pump CABG procedures, and 30 (35.7%) underwent off-pump CABG procedures. The study found no statistically significant difference in mortality rates between these two techniques. Mortality occurred in 12 patients (22.2%) in the on-pump group and in nine (30%) in the off-pump group. Complete revascularisation was performed on 46 patients (85.2%) in the on-pump group and seven (23.3%) in the off-pump group (p < 0.001).ConclusionAdvanced age, impaired NYHA functional capacity and pre-operative hypertension were determinative for early-term surgical mortality. An on-pump surgical technique is recommended to ensure completeness of revascularisation.

Traditional predictors of in-hospital mortality after coronary artery bypass grafting: Current status

“…Isolated systolic hypertension (systolic blood pressure (SBP) >140 mmHg) only was reported to be associated with adverse outcomes after CABG, causing a 40% increase in the likelihood of postoperative morbidity [25]. Recent studies reported hypertension among risk factors associated with early mortality in haemodialysis patients undergoing CABG [26], and it has been considered with other demographic risk factors among predictors of AF after CABG [27].…”

Ultrastructural examination of left internal mammary artery under electron microscopy in patients with chronic kidney disease who underwent coronary bypass surgery

“…Although mortality rates are higher in CKD patients compared to normal population, satisfactory results can be achieved if these patients are operated with correct indications when diagnosed with coronary artery disease. Today CABG operations can be performed with very low morbidity and mortality rates [8][9][10][11]. Positive results were obtained from all studies conducted on patency rates on IMA and examination of its histomorphological features.…”

“…Capability to widely and successfully perform topic that these operations could also be performed in patients with accompanying highrisk group diseases of other systems. Today, in patients with chronic kidney disease, coronary artery bypass grafting (CABG) surgery has been gradually increased and successfully performed [8][9][10][11]. Structural and functional properties of conduits during the surgical myocardial revascularization is of important issue which affects the success of the surgery [12,13].…”

Clinical Outcomes After Coronary Artery Bypass Grafting in Patients with Dialysis-Dependent End-Stage Renal Disease and an Analysis of the Related Influencing Factors

“…Multiple factors are related to perioperative mortality, namely, surgical complexity, preoperative cardiac function grade IV (New York Heart Association classi cation), preoperative acute myocardial infarction, combined surgery, aortic surgery, age ≥ 70 years, history of heart failure, PAD, female sex, dialysis dependence ≥ 5 years, emergency surgery, and preoperative hypertension. 1,6,7,8) Jault et al retrospectively analyzed the results of cardiac surgery in 124 patients receiving dialysis. Of these patients, 46% constituted the coronary heart disease group (group 1), 29.8% constituted the valvular disease group (group 2), 14.5% constituted the coronary heart disease and valvular disease group (group 3), and 9.6% constituted the high-risk disease group (group 4) with conditions such as emergency, secondary, and complex diseases; aortic dissection; aortic aneurysm; and prosthetic valve endocarditis; 14.5% of patients had diabetes mellitus, resulting in an overall mortality of 16.9%.…”