Cardiovascular Journal of Africa: Vol 28 No 2 (March/April 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017

108

AFRICA

Factors associated with early mortality in haemodialysis

patients undergoing coronary artery bypass surgery

Deniz Çevirme, Taylan Adademir, Mehmet Aksüt, Tülay Örki, Kamil Cantürk Çakala

lu, Mete Alp,

Kaan Kırali

Abstract

Introduction:

Coronary artery bypass grafting (CABG) results

in higher morbidity and mortality rates in end-stage renal

disease (ESRD) patient populations than in patients with

normal renal function. This study aimed to identify the early

results of CABG performed on ESRD patients, and the

factors that affected the mortality rates of those patients.

Methods:

A retrospective evaluation of our hospital database

revealed 84 haemodialysis-receiving patients who underwent

CABG during the years 2006 to 2012. Mortality was observed

in 21 patients (group 1), and this group was compared with

the remaining patients (group 2) for peri-operative parameters

such as age, EuroSCORE, functional capacity, myocardial

infarction, use of inotropes and completeness of revasculari-

sation.

Results:

The study included 60 male (71.4%) and 24 female

patients (28.6%); the participants’ mean age was 59.50

9.93 years. The pre-operative additive EuroSCORE was

7.96

2.88 (range: 2–18). Pre-operative functional capac-

ity was impaired in 35.7% of the patients [New York Heart

Association (NYHA) classes III–IV]. Mean age and pre-

operative EuroSCORE values of group 1 were significantly

higher than those of group 2. Impaired functional capacity

(NHYA classes III–IV) was also associated with mortality

(OR: 3.333; 95% CI: 1.199–9.268).

Fifty-four patients (64.3%) underwent on-pump CABG

procedures, and 30 (35.7%) underwent off-pump CABG

procedures. The study found no statistically significant differ-

ence in mortality rates between these two techniques. Mortal-

ity occurred in 12 patients (22.2%) in the on-pump group and

in nine (30%) in the off-pump group. Complete revascularisa-

tion was performed on 46 patients (85.2%) in the on-pump

group and seven (23.3%) in the off-pump group (

0.001).

Conclusion:

Advanced age, impaired NYHA functional capac-

ity and pre-operative hypertension were determinative for

early-term surgical mortality. An on-pump surgical technique

is recommended to ensure completeness of revascularisation.

Keywords:

coronary artery bypass surgery, chronic renal failure,

haemodialysis, off-pump, on-pump

Submitted 7/12/15, accepted 29/5/16

Published online 22/7/16

Cardiovasc J Afr

2017;

: 108–111

www.cvja.co.za

DOI: 10.5830/CVJA-2016-066

The mortality rate of end-stage renal disease (ESRD) patients

undergoing haemodialysis is high and over half of the deaths

are due to cardiovascular problems.

1,2

Coronary artery disease,

heart failure and sudden death are the most common causes

of morbidity.

Coronary artery disease (CAD) is seen five to 20

times more frequently in uraemic patients than in the normal

population. Because the lesions are widespread and complex,

clinical prognoses worsen rapidly.

Myocardial ischaemia is

present because of some triggering situations in the absence of

severe CAD.

Heart failure occurs frequently in ESRD patients and is

an independent predictor of mortality. Forty per cent of

haemodialysis patients experience heart failure symptoms at

the beginning of the procedure, and 25% of asymptomatic

patients will develop heart failure within 3.5 years.

6,7

The pre-,

intra- and postoperative periods of coronary artery bypass

graft (CABG) surgery must be treated more cautiously in this

population. Factors affecting the morbidity and mortality

rates of these patients must be well known to ensure that

careful and appropriate follow up takes place. On-pump versus

off-pump techniques, bleeding complications, and duration of

postoperative intensive care period are among the main concerns

with regard to this surgery.

The aim of this study was to identify the factors affecting

the mortality rate of ESRD patients who were receiving

haemodialysis and had undergone CABG procedures.

Methods

Eighty-four chronic renal failure patients who were receiving

haemodialysis and underwent CABG operations during the

period 2006 to 2012 were assessed in this retrospective study.

Data collection was approved by the institutional review board

of our hospital and was performed in accordance with the

board’s regulations.

All the patients underwent haemodialysis three times per week

during the pre-operative period, and routine CABG procedures

were administered to all of them. Haemodialysis was routinely

performed the day before and the day after the operation.

Narcotic anaesthesia was administered intravenously to all

patients. Full median sternotomy was performed on all patients;

the left internal mammarian artery and the saphenous vein were

Department of Cardiovascular Surgery, Kartal Ko

uyolu

Heart and Research Hospital, Istanbul, Turkey

Deniz Çevirme, MD

Taylan Adademir, MD,

taylanadademir@gmail.com

Mehmet Aksüt, MD

Kamil Cantürk Çakala

lu, MD

Mete Alp, MD

Kaan Kırali, MD

Department of Anesthesiology, Kartal Ko

uyolu Heart and

Research Hospital, Istanbul, Turkey

Tülay Örki, MD