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Coronary Artery Bypass Surgery in Patients on Chronic Hemodialysis: A Case-Control Study

Ezra Deutsch, MD; Robert C. Bernstein, MD; V. Paul Addonizio, MD; and William G. Kussmaul III, MD
[+] Article, Author, and Disclosure Information

Grant Support: Dr. Kussmaul is supported in part by a Measey Foundation Fellowship, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Requests for Reprints: William G. Kussmaul III, MD, Cardiac Catheterization Laboratory, 993 Founders Pavilion, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

Current Author Addresses: Drs. Kussmaul and Bernstein: Cardiology Section, Department of Medicine, and Dr. Addonizio, Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.

Dr. Deutsch: Cardiology Section, Temple University Health Science Center, Philadelphia, PA 19130.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(5):369-372. doi:10.7326/0003-4819-110-5-369
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Study Objective: To determine the morbidity and mortality of cardiac catheterization and coronary artery bypass surgery in patients on chronic hemodialysis.

Design: Retrospective case-control study.

Setting: A referral-based university hospital.

Patients: Sixteen consecutive patients on chronic hemodialysis who had catheterization and bypass surgery; 30 controls matched for age, sex, year of operation, severity of coronary disease, left ventricular function, hypertension, diabetes, and urgency of surgery; and 34 consecutive controls having bypass surgery.

Measurements and Main Results: No major complications of catheterization occurred. Of 16 patients on dialysis, 7 had urgent surgery within 24 hours of catheterization. One patient on dialysis and 3 consecutive controls died, but none of the matched controls died. Postoperative morbidity was increased in the hemodialysis group as measured by the duration of mechanical ventilation (4.7 ± 2.3 compared with 1.5 ± 0.8 days in matched controls [mean ± SE]), the duration of hemodynamic support (4.2 ± 2.3 compared with 0.8 ± 0.2 days), the length of stay in the intensive care unit (6.4 ± 2.4 compared with 2.8 ± 0.9 days), and the length of postoperative stay in the hospital (15.4 ± 2.1 compared with 10.8 ± 1.1 days) (all P < 0.05). Four intraoperative myocardial infarctions occurred in patients on dialysis compared with two patients in the case-matched controls. Differences in morbidity between the two control groups were not significant.

Conclusions: Morbidity is increased in patients on hemodialysis having coronary artery bypass surgery compared with controls matched for severity of coronary disease; however, the outcome in all but one patient on dialysis was good. Bypass surgery is an acceptable treatment for patients on dialysis with advanced coronary artery disease. Because urgent surgery is often needed in these patients, earlier evaluation of the need for revascularization may improve clinical results.





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