Immediate results of coronary bypass surgery on a "working heart" in patients with end-stage IHD with chronic kidney disease receiving treatment with program hemodialysis

Objective: to identify the features of performing coronary bypass surgery (CABG) on a "working heart" in patients with end-stage chronic renal failure (ESRF), receiving treatment with program hemodialysis (PHD).

Material and methods: in the cardiosurgical Department No. 1 OF the Irkutsk Regional Clinical Hospital from 2010 to 2020, 4468 CABG operations were performed on a "working heart". Of these, 10 (0.2%) of surgeries in patients with IHD ESRF receiving PHD. To solve this problem, two groups of operated patients were formed. The first group of patients with ESRF receiving PHD, and the second group (control) of 20 patients with normal kidney function. Comparison of patients in the groups was carried out by the volume of blood loss by drains, time of ventilator, stay in the hospital, the dynamics of creatinine, urea, potassium and HB, the number of red blood cells, platelets.

Results: operated patients with ESRF did not significantly differ in comparison with patients with normal kidney function in terms of the number of complications, ventilator time (p =0.97), ICU stay (p=0.06) and hospital stay, volume of blood loss by drainage (p=0.3). After surgery, patients with normal kidney function (group 2) showed a significant decrease in the number of red blood cells and platelets, HB levels without significant changes in the level of urea, creatinine and potassium in the blood. Similar changes were observed in the General and biochemical blood analysis in patients with ESRF (the first group).

Conclusion: the immediate results of CABG surgery on a "working heart" in patients with ESRF receiving HD do not differ from the results of coronary bypass surgery in patients with IHD with normal kidney function. The operation does not violate the planned completion of the HD. When performing a coronary bypass operation without artificial blood circulation on a "working heart", a standard approach for pre - and postoperative management of patients with ESRF is acceptable.

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