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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017
AFRICA
111
our research indicate that there was no statistically significant
difference between pre-operative risk factors and postoperative
parameters of patients with kidney failure who were operated on
with the use of off- and on-pump techniques. The results of the
mortality evaluations were likewise statistically insignificant.
Generally, complete revascularisation is the preferred
approach in CABG surgery, and one of the important goals
is to provide patients with good long-term NYHA functional
status.
14,15
Incomplete revascularisation is applied in certain cases.
In a study performed by Caputo
et al
., the results of
incomplete and complete revascularisation with the use of
off-pump techniques were compared, and a two-year follow
up determined that the risk of mortality for the patients with
incomplete revascularisation exhibited a statistically significant
increase, compared to that of the other group.
16
In-hospital
mortality and peri-operative myocardial infarction rates were
also observed to be considerably higher for the group of
patients on whom incomplete revascularisation was performed.
According to the data obtained from patients with chronic
renal failure, incomplete revascularisation was performed on 23
patients (76.7%) in the off-pump group and four (14.8%) in the
on-pump group. Complete revascularisation was found to be
more prominent in the on-pump group of 46 patients (85.2%).
Two studies showed reduced platelet counts and platelet
dysfunction (reduced platelet adhesiveness) due to uraemia, and
an abnormal von Willebrand factor led to bleeding in chronic renal
failure patients receiving haemodialysis.
17,18
Nakatsu and colleagues
noted the risk of haemorrhagic complications associated with
heart valve surgery in ESRD patients. They found similar risk rates
in bioprosthesis and mechanical heart valve patients.
19
Prolonged extubation time and ICU stay are interrelated
parameters. Pneumonia complications are due these extended
times.
This cohort study had several limitations. Because it was a
typical retrospective study, it suffered from lack of randomisation.
The patient population was relatively small, which may have
reduced our ability to detect statistically significant differences.
Conclusion
Coronary artery bypass surgery is a highly risky approach for
patients suffering from ESRD. On-pump surgery is preferred for
the best surgical results, especially in elderly and high-risk patients.
Peri-operative MI and an increased CK-MB level are predictive
factors for mortality. However, uncontrolled hypertension and
low functional capacity (NYHA) are independent determinants
of mortality for this patient group.
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