TY - JOUR
T1 - Coronary Artery Bypass Graft Patency and Survival in Patients on Dialysis
AU - Siddiqi, Shirin
AU - Ravichandren, Kirthi
AU - Soltesz, Edward G.
AU - Johnston, Douglas R.
AU - Roselli, Eric E.
AU - Tong, Michael Z.
AU - Navia, Jose L.
AU - Elgharably, Haytham
AU - Ayyat, Kamal
AU - Houghtaling, Penny L.
AU - Pettersson, Gösta B.
AU - Blackstone, Eugene H.
AU - Svensson, Lars G.
AU - Bakaeen, Faisal G.
N1 - Funding Information:
This work was supported by the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery, held by Dr Bakaeen.
Funding Information:
This work was supported by the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery, held by Dr Bakaeen. Authors' contributions: Study conception was contributed by all the authors. Data collection was carried out by S.S. Investigation was performed by P.H. H.E. and K.A. Writing was contributed by S.S. K.R. F.B. P.H. and E.B. Critical review and revision was performed by all the authors. for all aspects of the work contributed by all the authors.
Publisher Copyright:
© 2020 The Author(s)
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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.
KW - Internal thoracic artery grafts
KW - Saphenous vein grafts
UR - http://www.scopus.com/inward/record.url?scp=85084217771&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084217771&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2020.03.069
DO - 10.1016/j.jss.2020.03.069
M3 - Article
C2 - 32388058
AN - SCOPUS:85084217771
SN - 0022-4804
VL - 254
SP - 1
EP - 6
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -