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Myocardial Revascularization in Chronic Renal Failure: 10-year Experience

Institute of Cardiovascular Surgery University of La Sapienza Rome, Italy 1 Institute of Thoracic and Cardiovascular Surgery University of Siena Siena, Italy
For reprint information contact: Edvin Prifti, MD Tel: 39 05 8549 3522 Fax: 39 05 8549 3616 email: edvinprifti{at}hotmail.com Institute of Cardiac Surgery and Great Vessels, University of La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, Rome 00161, Italy.

From January 1989 to June 1999, 244 patients with chronic renal failure underwent myocardial revascularization, of whom 56 were undergoing hemodialysis (group 1) and 188 (group 2) did not require hemodialysis. Mean age was 63.4 ± 6.5 years in group 1 and 65.4 ± 7 years in group 2. Hospital mortality was 7% overall; 6 (10.7%) patients died in group 1 versus 11 (5.9%) in group 2 (p > 0.05). Post-operative complications were significantly higher in group 1 versus group 2. Multivariate analysis revealed cerebrovascular disease, myocardial infarction, left ventricular ejection fraction < 35%, and duration of renal failure as strong predictors of poor survival in non-dialysis patients. Left ventricular ejection fraction < 35% and duration of hemodialysis were predictors of late mortality in group 1. The 1-, 3-, and 5-year survival rates were 90%, 76%, and 68% in group 1, and 95.5%, 86%, and 80.7% in group 2 (p < 0.004), respectively. Myocardial revascularization can be carried out in patients with chronic renal failure with acceptable early and late mortality and morbidity, but those undergoing hemodialysis are at substantial risk of major morbid events and poor long-term survival.