Our Summary

This research paper is about how cardiovascular disease, which is the leading cause of death among patients who require dialysis, is affected by a surgical procedure called coronary artery bypass grafting (CABG). This procedure is performed on patients who have severe coronary artery disease, a condition where the blood vessels that supply the heart are blocked.

As the number of people with end-stage renal disease (a condition where the kidneys have stopped working) increases globally, so does the number of patients needing dialysis. These patients often require CABG but are complex cases because their blood flow and body functions have changed significantly due to their kidney disease. These changes can make the surgery more complicated.

The paper first reviews existing research on the outcomes and factors that can predict the results of CABG surgery in dialysis patients. Then, it discusses the complex decisions that need to be made around the surgery, such as whether to use a heart-lung machine (which temporarily takes over the function of the heart and lungs during surgery) and what type of blood vessel to use for the bypass graft.

FAQs

  1. What is the leading cause of mortality in dialysis-dependent patients?
  2. How do changes in haemodynamic and physiologic profiles complicate revascularisation surgery for dialysis-dependent patients?
  3. What are some important peri-operative decisions that need to be made when a dialysis-dependent patient undergoes CABG?

Doctor’s Tip

One helpful tip a doctor might tell a patient about CABG is to carefully follow all post-operative instructions, including taking medications as prescribed, attending follow-up appointments, and participating in cardiac rehabilitation. These steps are crucial for a successful recovery and long-term outcomes following bypass surgery.

Suitable For

Patients who are typically recommended for CABG include those with severe coronary artery disease, particularly those who have not responded well to medical management or less invasive procedures. Dialysis-dependent patients, who are at high risk for cardiovascular disease, are also often recommended for CABG due to the complexity of their condition and the need for revascularisation surgery. Other factors that may indicate a need for CABG include multiple blockages in the coronary arteries, left main coronary artery disease, and significant symptoms such as angina or shortness of breath. Ultimately, the decision to recommend CABG is based on a thorough evaluation of the patient’s overall health and the potential benefits of surgery.

Timeline

Before CABG:

  1. Patient is diagnosed with severe coronary artery disease.
  2. Patient undergoes pre-operative evaluation, including imaging tests and blood work.
  3. Patient may need to make lifestyle changes or take medications to optimize their health before surgery.

During CABG:

  1. Patient is admitted to the hospital and prepared for surgery.
  2. Surgery is performed, which involves creating new routes for blood to flow to the heart by using blood vessels from other parts of the body.
  3. Patient may be placed on a heart-lung machine during the surgery to maintain blood flow and oxygen levels.

After CABG:

  1. Patient is monitored closely in the intensive care unit (ICU) for several days post-surgery.
  2. Patient may experience pain, fatigue, and difficulty breathing in the days following surgery.
  3. Patient undergoes rehabilitation and physical therapy to regain strength and function.
  4. Patient is discharged from the hospital and continues to follow-up with their healthcare team for monitoring and management of their heart health.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing CABG surgery as a dialysis-dependent patient?
  2. How will my dialysis treatment be managed before, during, and after the surgery?
  3. What is the expected recovery time and rehabilitation process after CABG surgery?
  4. How will my medications, including those for dialysis and heart health, be managed post-surgery?
  5. Are there any specific lifestyle changes or precautions I should take to improve the success of the surgery and my overall health?
  6. What are the potential long-term outcomes and complications I should be aware of as a dialysis-dependent patient undergoing CABG surgery?
  7. Are there any alternative treatment options or minimally invasive procedures that may be suitable for my condition?
  8. How often will follow-up appointments be needed after surgery to monitor my progress and address any concerns?
  9. What can I do to optimize my chances of a successful outcome from CABG surgery as a dialysis-dependent patient?
  10. Are there any specific questions or concerns I should discuss with my nephrologist or other healthcare providers before proceeding with CABG surgery?

Reference

Authors: Shell D. Journal: Cardiovasc Revasc Med. 2023 Sep;54:73-80. doi: 10.1016/j.carrev.2023.05.007. Epub 2023 May 10. PMID: 37183155