Long-Term Outcomes in Coronary Artery Bypass Graft Patients Using Internal Thoracic Artery with Ipsilateral Arteriovenous Shunt for Hemodialysis

Abstract

Background: The goal of this study was to evaluate the long-term results of coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) grafts in hemodialysis (HD) patients with arteriovenous (AV) fistulae or AV grafts involving the ipsilateral or contralateral brachial artery or radial artery.

Methods: From March 2007 to May 2017, 76 end-stage renal disease (ESRD) patients with an upper limb AV fistula or graft for HD underwent CABG at a single center. Group A included 23 patients who underwent CABG using an ITA graft ipsilateral to the AV vascular access (AVVA); Group B included 22 patients who underwent CABG using a contralateral ITA with AVVA; and Group C included 29 patients who underwent CABG with AVVA without the use of an ITA graft. The primary end-point was death from any cause.

Results: The average follow-up period was 34.4 ± 26.9 months. Death from any cause occurred in 6 (26.09%) patients in Group A, 8 (36.36%) patients in Group B, and 17 (58.62%) patients in Group C (log-rank p = 0.04). There was no significant difference in death rate between Groups A and B. The risk of death was lower in the patients with CABG using an ITA graft (ITA CABG) compared to the patients without ITA CABG [HR 0.41 (95% CI, 0.20-0.84), p = 0.015].

Conclusions: The HD patients who underwent CABG with an ipsilateral location of the ITA and AVVA did not have an increased risk of death compared to the patients who underwent CABG with a contralateral location of the ITA and AVVA. In addition, the use of ITA in CABG resulted in better outcomes in the HD patients.

Keywords: Chronic renal failure; Coronary artery bypass graft; Steal phenomenon; Uremia.

Figure 1

Black arrow head is left internal thoracic artery. White arrow head is radial artery graft. White arrow is that left internal thoracic artery was end-to-side anastmosed with radial artery graft as T-graft.

Figure 2

86 patients have been underwent isolated CABG and hemodialysis. After 12 patients were excluded, only 74 patients were included. According to their graft type and location, they were divided into three groups.

Figure 3

The Kaplan-Meier survival curves of the three groups (log-rank p = 0.04). Group A comprised patients underwent CABG using internal thoracic artery graft (ITA) ipsilateral to the AV shunt; group B comprised patients underwent CABG using a contralateral ITA with AV shunt; group C comprised patients underwent CABG with AV shunt without use of ITA.

Figure 4

The Kaplan-Meier survival curves of the two groups (log-rank p = 0.012). Group A+B comprised patients who received CABG with the use of internal thoracic artery (ITA); Group C comprised those who received CABG without ITA.