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Eur J Cardiothorac Surg 2001;20:565-572
© 2001 Elsevier Science NL

Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine 2.0 mg/dl)

^a Department of Cardiovascular Surgery, Kobari General Hospital, 29-1 Yokouchi, Noda City, Chiba, 278-8501 Japan
^b Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan

Received 9 January 2001; received in revised form 16 May 2001; accepted 31 May 2001.

Corresponding author. Tel.: +81-471-24-6666; fax: +81-471-24-6764
e-mail: genex{at}nifty.com

Introduction: Patients with renal dysfunction carry a risk of coronary atherosclerosis. The purpose of this study was to evaluate the outcome after coronary artery bypass grafting (CABG) in patients with decreased renal function (serum creatinine 2.0 mg/dl). Methods: We retrospectively analyzed consecutive patients who had undergone isolated CABG at Shin-Tokyo Hospital between May 1, 1991 and April 31, 2000. Preoperative, perioperative, and follow-up data of the non-dialysis-dependent patients with preoperative serum creatinine equal to or more than 2.0 mg/dl (group R, n=59) were collected, and compared with those of the control patients (serum creatinine <2.0, group C, n=1666). Group R was further divided into the off-pump and on-pump CABG group and their perioperative results were compared. Results: Group R included 51 males and eight females with a mean age of 66.4. The mean number of anastomoses was not significantly different between groups; however, clump time and pump time were longer in group R. Postoperative recovery was longer in group R than in group C, which is associated with a more frequent occurrence of major complications (28.8% in group R and 10.7% in group C, P<0.0001) and mortalities (6.8% in group R and 0.5% in group C, P<0.0005). The patients who underwent off-pump CABG experienced relatively faster recovery than those who underwent on-pump CABG, despite decreased renal function. At the mean follow-up of 2.4 years, the actuarial 3-year survival rate of groups R and C were 75.3 and 96.9%, respectively (P<0.0001), excluding hospital mortality. The actuarial 3-year cardiac event-free rate was 76.7% in group R and 87.3% in group C (P<0.05). Conclusions: Patients with decreased renal function carry significant operative risks and require prolonged hospital care. Even after adequate surgical revascularization was completed, the long-term cardiac event-free and survival rates in the patients with renal dysfunction were inferior to the patients with normal renal function.

Key Words: Coronary artery disease • Renal failure • Long-term result • Coronary artery bypass graft

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