Coronary Artery Bypass Surgery in Hemodialysis

The article in this journal by Siegel et al, (see p 83,) which describes a patient who was maintained on chronic dialysis and who successfully underwent coronary artery bypass surgery, complements previous reports describing similar successes1-4and further confirms that major surgery,5including valvular and cardiac surgery, can6-9be undertaken with a reasonably low risk in patients with renal failure. The most extensive study evaluating coronary bypass surgery in patients with renal failure has been published by Kuehnel et al,4who described six patients with creatinine clearances of less than 15 ml/min and three with creatinine clearances of less than 5 ml/min, who were maintained on chronic dialysis. All six patients had grade III or IV angina (New York Heart Association classification) preoperatively, and all demonstrated substantial improvement of angina postoperatively to a grade I in five and to grade II in one patient. The three