Early Results of Coronary Artery Bypass Grafting in Patients on Dialysis

Ahmed Abdalla Mohamed¹, Ahmed Mohamed Elshemy¹, Wael Shahat Nekhila²

Keywords: End-stage renal disease, cardiovascular surgical procedures, risk assessment, internal mammary-coronary artery anastomosis, perioperative care

DOI: 10.63475/yjm.v5i1.0272

DOI URL: https://doi.org/10.63475/yjm.v5i1.0272

Publish Date: 05-04-2026

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Author Affiliation:

1 MD, PhD, Assistant Consultant Cardiothoracic Surgery, National Heart Institute, Cairo, Egypt
2 Fellow of Cardiothoracic Surgery, Cardiac Surgery Department, National Heart Institute, Cairo, Egypt

Abstract

Background: While coronary artery bypass grafting CABG (Coronary Artery Bypass Grafting) is the preferred revascularization strategy for multi-vessel disease in dialysis patients, perioperative risk remains prohibitive. The relative prognostic importance of renal versus cardiac parameters is poorly defined, and the optimal surgical conduit strategy is debated. This study aimed to evaluate the early mortality and morbidity of dialysis-dependent patients undergoing isolated CABG and to identify independent predictors of early survival.

Methods: We prospectively studied 100 dialysis-dependent patients undergoing isolated CABG under a standardised multidisciplinary protocol conducted between January 2022 and March 2023 in the National Heart Institute, Cairo, Egypt. We analysed early (30-day) outcomes and performed regression modelling to identify predictors of mortality.

Results: We observed an early mortality rate of 7%. Contrary to conventional cardiac surgical risk models, in this exploratory multivariate model, we identified elevated baseline serum creatinin (odds ratio, 3.46; P = 0.029) as a potential independent predictor of death; left ventricular function was not predictive. The cohort exhibited a distinct morbidity profile, with high rates of bleeding (11%) and infection (3%). Notably, the left internal mammary artery was utilized in only 6% of cases, with saphenous vein grafts serving as the primary conduit for revascularization.

Conclusions: This study challenges the primacy of cardiac metrics in risk-stratifying dialysis patients for CABG, establishing preoperative renal function as the dominant prognostic factor. Our findings justify a paradigm shift in preoperative optimization and support a patientcentered surgical approach that may selectively eschew standard arterial grafting to safeguard critical dialysis access. This tailored strategy yielded mortality rates favorable to contemporary benchmarks.

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