LIMA Grafting Improves Survival in Dialysis Patients, with Sex Differences: Study

A new study published in the Journal of the American Medical Association revealed that among patients with kidney failure on dialysis, Left Internal Mammary Artery (LIMA) grafting was associated with better survival when compared to saphenous vein graft (SVG) alone. However, multiple arterial grafting (MAG) did not show additional survival benefit over LIMA grafting. Men had significantly better 5-year survival than women after arterial grafting, whereas outcomes with SVG alone were similar between sexes.

Patients with kidney failure already face significantly higher risks when undergoing major cardiac procedures like coronary artery bypass grafting (CABG). The added burden of dialysis complicates recovery and survival, making surgical decisions especially critical. Thus, this new study explores how sex differences play out specifically among dialysis patients.

This research analyzed data from over 15,000 patients recorded in the US Renal Data System from 2015 to 2020. All patients were undergoing hemodialysis at the time of their heart surgery and had not received a prior kidney transplant. The study compared different grafting strategies used during CABG, particularly focusing on arterial grafting methods such as LIMA grafting and MAG, against traditional SVG.

The results showed that both men and women benefited from LIMA grafting when compared to SVG alone. The 5-year survival rates improved modestly in both groups, suggesting that arterial grafting remains a preferable option overall. 

Men consistently had higher 5-year survival rates than women following arterial grafting procedures. This difference was especially pronounced in patients who underwent MAG. While nearly 39% of men who received MAG survived at 5 years, the survival rate for women was just 17% which points the concerns about how these procedures affect female patients.

When only SVG was used, survival differences between men and women were not statistically significant. This suggests that the type of grafting technique chosen may interact with biological or clinical differences between sexes in ways that are not yet fully understood.

Since the study group among women receiving MAG were relatively small, further investigation will be required to clarify the consistent pattern across sexes. Overall, the findings of this study illuminates the need for more customized approaches to cardiac surgery in high-risk populations. In women with kidney failure on dialysis, the benefits of advanced arterial grafting techniques may not be as clear as previously thought.

Source:

Yang, C., Singh, S., Kirilina, D., Ogami, T., Stevens, J., Mohan, S., Takeda, K., & Kurlansky, P. (2026). Sex differences in arterial grafting in patients undergoing dialysis and coronary artery bypass grafting. JAMA Surgery. https://doi.org/10.1001/jamasurg.2026.0637