Long-term survival after coronary arterial grafts in patients with end-stage renal disease.

Abstract

Bilateral internal thoracic artery (BITA) grafting is known to improve the long-term survival after coronary artery bypass grafting (CABG). However, there are few reports regarding the efficacy of BITA grafting in end-stage renal disease (ESRD) patients. This study investigates the potential benefits of BITA grafting in ESRD patients. One hundred thirty ESRD patients dependent on chronic hemodialysis underwent isolated CABG in the Kumamoto Central Hospital from 1988 to 2009. The early results and long-term outcomes in 49 patients using BITA (BITA group) were compared with 81 patients using a single ITA (SITA group). The mean follow-up time was 5.2 +/- 3.8 years. The mortality rate was 4.9% for the SITA group and 4.1% for the BITA group (p = 0.8215). No differences were seen for the incidence of mediastinitis or a rethoracotomy for bleeding. The 3-year, 5-year, 7-year, and 10-year survival rates in the SITA group were 79.6%, 62.5%, 43.6%, and 22.6%, respectively. The corresponding survival rates in the BITA group were 76.0%, 61.9%, 58.8%, and 33.2%, respectively. There were no statistical differences in survival (p = 0.1636), freedom from cardiac death (p = 0.3205), or freedom from cardiac events (p = 0.4071). In ESRD patients without diabetes mellitus, BITA grafting improves the outcomes concerning cardiac events (p = 0.0143). After a long-term follow-up, CABG with BITA grafts showed no advantages in the long-term outcomes among ESRD patients. However, for ESRD patients without diabetes mellitus, BITA grafting may provide more promising long-term outcomes.