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Coronary Artery Bypass Graft Patency and Survival in Patients on Dialysis. | LitMetric

AI Article Synopsis

  • The study investigates the success of heart bypass grafts in patients on dialysis, focusing on the internal thoracic artery (ITA) and saphenous vein grafts (SVGs) after coronary artery bypass grafting (CABG).
  • Data collected from 500 patients over 21 years showed that while ITA grafts had a low occlusion rate, SVGs had significantly lower patency rates than expected, with only 52% and 37% remaining open at 1 and 2 years, respectively.
  • The findings highlight the need for better graft selection and strategies to improve graft success in this high-risk patient group, due to their poor overall prognosis.

Article Abstract

Background: Little is known about graft patency after coronary artery bypass grafting (CABG) performed in patients on dialysis. Our aim was to assess patency of internal thoracic artery (ITA) grafts and saphenous vein grafts (SVGs) in these patients.

Methods: From 1/1997 to 1/2018, 500 patients on dialysis underwent primary CABG with or without concomitant procedures at Cleveland Clinic, 40 of whom had 48 postoperative angiograms for recurrent ischemic symptoms. Complete follow-up was obtained on all but 1 patient lost to follow-up 1 y after CABG. Thirty-six ITA grafts and 65 SVGs were evaluable for stenosis and occlusion.

Results: Two of 40 patients (5%) had emergency CABG; 3 (7.5%) with calcified aortas had a change in operative strategy to avoid ascending aortic manipulation, 2 (5%) had poor conduit quality, and 12 (30%) had severe diffuse atherosclerotic disease with calcification of the coronary targets causing technical difficulties. Thirty-three patients (82%) were bypassed with an in situ ITA and 3 (7.5%) had a free ITA graft. Three of 36 ITA grafts were occluded at 0.78, 1.8, and 9.4 y (too few to model). SVG patency was 52% and 37% at 1 and 2 y, respectively.

Conclusions: Among patients on dialysis who underwent CABG, coronary angiography for ischemic symptoms in a select subset revealed that SVG patency was lower than expected from published reports in the general CABG population and may contribute to the poor prognosis of this cohort. Further work is needed to guide graft selection and improve graft patency in dialysis patients.

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Source
http://dx.doi.org/10.1016/j.jss.2020.03.069DOI Listing

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