CORONARY-ARTERY BYPASS OPERATION IN DIALYSIS PATIENTS

To analyze the short- and long-term morbidity and mortality among maintenance dialysis patients who have undergone coronary artery bypass operations, we identified 25 such patients at the Mayo Clinic and three recently published large single-center studies that provided sufficient detail for meaningful comparison. Two independent observers reviewed the new information with regard to pertinent historical, clinical, and laboratory data. The perioperative mortality was 20%. Among the perioperative survivors, 1- and 2-year survival rates were 95% and 77%, respectively. The 3-year actuarial survival was 70%. Uniformly, the symptoms diminished, and the need for antianginal medication was decreased. In the three other large published series, the perioperative mortality ranged from 3 to 20%, and coronary artery bypass performed earlier after the onset of the symptoms seemed to result in a lower perioperative mortality. We conclude that elective coronary artery bypass in dialysis patients is associated with acceptable short-term morbidity and mortality and effective relief of symptoms. Surgically treated patients may have a survival advantage. Thus, we advocate aggressive early investigation and surgical treatment of these patients.